# Reverse Slanting of Split Eyebrows and

Palpebral Fissures: A New Dysmorphic Syndrome

Aamir Jalal Al Mosawi Abstract-A dysmorphic syndrome is suspected in the presence of more than three minor anomalies which are variations of normal morphological features that are considered of little or no known medical, surgical, or cosmetic significance; more than one major anomaly which is an abnormality that has major medical, surgical or cosmetic significance; and one major anomaly with two or more minor anomalies are also suggestive of congenital syndrome. Many congenital syndromes are associated with different combinations of hypertelorism (with or without flat mid-face), epicanthic folds, convergent squint, low set ears, upward and downward slanting of the palpebral fissures, and eyebrows abnormalities occurring in association with hypotonia and developmental delay.

The aim of this paper is to describe the occurrence of a new congenital syndrome with the novel association of unique eyebrows abnormalities (splitting with a relatively thick upward slanting medial parts and thin non-slanting lateral parts) with downward slanting palpebral fissures, bilateral convergent squint, hypertelorism with flat mid-face, epicanthic folds, large ears, developmental delay, and infantile hypotonia mostly attributed to congenital myopathy.


# I. Introduction

dysmorphic syndrome is suspected in the presence of more than three minor anomalies which are variations of normal morphological features that are considered of little or no known medical, surgical, or cosmetic significance; more than one major anomaly which is an abnormality that has major medical, surgical or cosmetic significance; and one major anomaly with two or more minor anomalies are also suggestive of congenital syndrome. Many congenital syndromes are associated with different combinations of hypertelorism (with or without flat midface), epicanthic folds, convergent squint, low set ears, upward and downward slanting of the palpebral fissures, and eyebrows abnormalities occurring in association with hypotonia and developmental delay [1,2,3,4].

The aim of this paper is to describe the occurrence of a new congenital syndrome with the novel association of unique eyebrows abnormalities (splitting with a relatively thick upward slanting medial parts and  


# EMG and nerve conduction studies were performed at the age of seven months (Table-1).

Nerve conduction study (Table - 


# Needle electromyography (EMG) stud showed:

No spontaneous activity.

No myotonic discharges.


# The average duration of 20 motor units:

Right deltoid= 5.1 msec (n=8.3 msec). Right biceps = 4.8 msec (n=8.1 msec). Right vastus medialis = 4.1 msec (n=8.3 msec). Right tibialis anterior = 5.3 msec (n= 10.2 msec). Left tibialis anterior = 5.2 msec (n= 12.5 msec). 30-40% polyphasia of short duration low amplitude was observed.

EMG and nerve conduction studies suggested chronic diffuse non dystrophic myopathic of moderate severity mostly resulting from congenital myopathy.

The proximal lower limb muscles were more severely involved. 


# Summarizes the clinical features of the new syndrome
1![Figure 1: The boy unique eyebrows abnormalities consisting of splitting with a relatively thick upward slanting medial parts and thin non-slanting lateral parts in association with downward slanting palpebral fissures, bilateral convergent squint, hypertelorism with flat mid-face, epicanthic folds, and large ears.](image-2.png "FFigure 1 :")

thin non-slanting lateral parts) with downward slantingpalpebral fissures, bilateral convergent squint,hypertelorism with flat mid-face, epicanthic folds, largeears, developmental delay, and infantile hypotoniamostly attributed to congenital myopathy.II. Case Report1. Highly specific unique eyebrows abnormalitiesconsisting of splitting with a relatively thick upwardslanting medial parts and thin non-slanting lateralparts.2. Downward slanting palpebral fissures.3. Epicanthic folds.4. Hypertelorism.5. Depressed nasal bridge.6. Large ears.7. Convergent squints of both eyes.Brain MRI was performed at the age of onemonth showed normal findings.Screening for several inborn errors ofmetabolisms has already revealed no abnormality.Author: 1. Advisor in Pediatrics and Pediatric Psychiatry Children Teaching Hospital of Baghdad Medical City. 2. Head, Iraq Headquarter of Copernicus Scientists International Panel, Baghdad, Ira. e-mail: almosawiAJ@yahoo.com A
2Sporadic occurrenceNon consanguineous parentsSplitting of eyebrows with a relatively thick upward slanting medial parts and thin non-slantinglateral partsDownward slanting palpebral fissuresEpicanthic foldsHypertelorismDepressed nasal bridgeLarge earsConvergent squints of both eyes.Infantile hypotonia attributed to congenital myopathy
1SensoryMotorNerveLatency msec/cmAmplitude ?VSNCV m/secMuscleDML Msec /cmMNCV msec /cmF-wave LatencyRight median2.126.656.2ABP3.150.216.5Right ulnar1.927.356.6ADM2.951.217.2Right common peronealTibialis Ant. EDB3.3 4.240.235.3Left common peronealTibialis Ant. EDB3 4.140.336.3Left sural215.344.6
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## Acknowledgement

The author would to express his gratitude for the parents of the patients who accepted publishing his photos.

			

			

				


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		Recognizable patterns of human malformation: genetic, embryologic, and clinical aspects". Major problems in clinical pediatrics
		
			SWDavid
		
		
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* 
	
		Rare genetic disorders in Iraq
		
			AJAl-Mosawi
		
		
			LAP Lambert Academic Publishing
			1
			2011
			Saarbrücken
		
	
	st ed.




* 
	
		The uncommon and rare genetic disorders in Iraq
		
			AJAl-Mosawi
		
		
			LAP Lambert Academic Publishing
			2019
			Saarbrücken
		
	
	st ed.