Walker-Warburg syndrome and tectocerebellar dysraphia: A novel association caused by a homozygous DAG1 mutation

Eur J Paediatr Neurol. 2018 May;22(3):525-531. doi: 10.1016/j.ejpn.2017.12.012. Epub 2017 Dec 26.


Objectives: To elaborate the imaging phenotype associated with a homozygous c.743C > del frameshift mutation in DAG1 leading to complete absence of both α- and β-dystroglycan previously reported in a consanguineous Israeli-Arab family.

Methods: We analyzed prenatal and postnatal imaging data of patients from a consanguineous Israeli-Arab kindred harboring the DAG1 mutation.

Results: The imaging studies (fetal ultrasound, CT scan and postnatal MRI) demonstrated: flat cortex (abnormally thick with irregular pebbled cortical-white matter border on MRI), hydrocephalus, scattered small periventricular heterotopia and subependymal hemorrhages and calcifications, z-shaped brainstem, and in addition an occipital encephalocele, vermian agenesis, and an elongated and thick tectum (tectocerebellar dysraphia).

Conclusions: The novel association of cobblestone malformation with tectocerebellar dysraphia as part of WWS is characteristic of the homozygous c.743C > del frameshift mutation in the DAG1 gene.

Keywords: Cobblestone malformation complex; DAG1; Dystroglycan; Tectocerebellar dysraphia; Walker-Warburg syndrome.

MeSH terms

  • Brain / diagnostic imaging*
  • Brain / pathology
  • Consanguinity
  • Dystroglycans / deficiency
  • Dystroglycans / genetics*
  • Female
  • Frameshift Mutation
  • Homozygote
  • Humans
  • Magnetic Resonance Imaging / methods
  • Male
  • Phenotype
  • Pregnancy
  • Tomography, X-Ray Computed
  • Ultrasonography, Prenatal
  • Walker-Warburg Syndrome / diagnostic imaging*
  • Walker-Warburg Syndrome / genetics*


  • DAG1 protein, human
  • Dystroglycans