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This chapter discusses neurocutaneous disorders, or phakomatoses, with an emphasis on neurologic symptoms as a presenting factor. These symptoms may include seizures, weakness, ataxia, or intellectual disabilities.



The tuberous sclerosis complex (TSC) was first described by Désire-Maloire Bourneville in 1880. It is an autosomal dominant multisystemic disease that results in a disruption of cell growth regulation in the brain, heart, kidneys, eyes, skin, and blood vessels. More recent studies estimate an incidence of 1 in 5800 live births. Recent guidelines have updated the clinical diagnostic criteria to include a known pathogenic variant (mutation) in 1 of 2 genes: TSC1 (Online Mendelian Inheritance in Man [OMIM] no. 191100) or TSC2 (OMIM no. 613254). The molecular pathogenesis of TSC is described below.

Table 567-1 summarizes the major and minor clinical diagnostic criteria and additional genetic diagnostic criteria. Most commonly, a diagnosis of TSC is first suspected either prenatally, due to cardiac rhabdomyomas and/or subependymal nodules detected on fetal ultrasound, or in infancy with the onset of seizures or infantile spasms. In 2012, the Tuberous Sclerosis Complex Consensus Group convened to finalize diagnostic criteria and surveillance recommendations and summarized the known incidence of each clinical finding.


Dermatologic findings comprise the most frequent and visible manifestation, with nearly all patients affected by TSC having at least 1 finding. Ninety percent of individuals with TSC have been reported to have 3 or more hypomelanotic macules (“ash leaf spots”) greater than 5 mm in diameter (Fig. 567-1) These typically occur at birth or infancy and, in pale skin, may be seen more clearly with a Wood’s lamp or ultraviolet A (UVA) lighting. It has also been suggested that an ...

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