# Midline defect with corpus callosum agenesis, vermian hypoplasia and median cleft lip palate

## TL;DR

A case report describes a fetus with multiple midline brain and facial abnormalities, including corpus callosum agenesis and cleft palate, with no identified genetic cause.

## Contribution

Presents a rare case of midline defects with no detectable genetic cause, highlighting the importance of prenatal imaging and genetic testing.

## Key findings

- Midline brain abnormalities and facial deformities were detected prenatally but no genetic cause was identified.
- Exome sequencing failed to reveal pathogenic or significant variants despite multiple anomalies.
- The case highlights the value of prenatal findings in guiding clinical decisions.

## Abstract

Midline defects in the brain may be related to genetic syndromes. Association with facial anomalies and skeletal deformities has been described.

In the present case, a routine second trimester scan revealed cerebral abnormalities (corpus callosum agenesis, cerebellar cleft due to vermian hypoplasia, ventriculomegaly), suspected cortical developmental disorder, hypertelorism, a hypoplastic nasal bone, a small median cleft lip and palate, abnormal facial profile, as well as syndactyly of the left hand involving the fourth and fifth finger. Genetic testing revealed a normal karyotype. Subsequent trio exome sequencing did not identify any pathogenic variants or variants of unknown significance. The vaginal delivery at term and postnatal adaptation were uneventful. Postnatal neurosonographic imaging and clinical evaluation confirmed the prenatal findings. Both mother and child were discharged in healthy condition with scheduled follow-ups. Differential diagnoses of the present anomalies include Hartsfield-Bixler-Demyer Syndrome, Oro-Facial-Digital-Syndromes, Ectrodactyly Ectodermal Dysplasia Cleft Lip/Palate Syndrome and Acrocallosal Syndrome.

Invasive diagnostic and genetic testing are recommended when multiple fetal anomalies suggest a potential genetic syndrome. While not all cases reveal an underlying genetic cause, prenatal findings can provide valuable information to help parents and healthcare providers make informed decisions about the continuation of the pregnancy.