00:01
So how do we diagnose TSC?
Well, again,
this is a genetic condition,
where we actually do more
clinical assessment
than gene testing in these patients.
00:10
And we're looking
for a number of findings
that's characteristic
of this condition,
and there are many.
00:16
So let's walk through them
in this table.
00:18
The most common thing that we see
are hypopigmented,
hypomelanotic macules,
Ash-leaf macules.
00:24
And you have to have
three or more
that are five millimeters
in diameter.
00:29
The second finding we look for
are angiofibromas,
or something called a
fibrous cephalic plaque.
00:35
Three or more angiofibromas,
or one fibrous cephalic plaque
is sufficient to meet one major
diagnostic criteria for TSC.
00:43
Ungual fibromas.
00:45
We talked about and
looked at it in pictures,
two or more are required
to meet a major criteria for TSC.
00:52
The Shagreen patch
is a major criteria.
00:55
Retinal hamartomas,
those angiofibromas,
those gross the tumors
that occur in the retina.
01:00
And we need two or more
to establish a major criterion.
01:04
Cortical tubers,
which we'll look at on imaging.
01:06
Subependymal nodules, which
we'll also look at on neuro imaging.
01:11
Cardiac tumors
like that cardiac rhabdomyoma
that we saw in the patient
in our case.
01:16
This interesting syndrome called
pulmonary lymphangioleiomyoma,
or LAM,
which is a pulmonary finding
that can be seen in adult patients
with TSC.
01:26
And if present is consistent to
fulfill a major criterion for TSC,
And angiomyolipomas or AMLs,
which are primarily seen
in the kidneys,
but can be seen in the liver.
01:37
That's a ton of things.
And to make a diagnosis of TSC
patients need at least
two major criteria,
or one major criteria
and a few minor criteria
that we'll talk about
on the next slide.
01:51
What are those minor criterion?
Well, these are things
that are less common
that can be seen out there
in the normal world,
but if present, and in the right
clinical context of other findings
suggests a diagnosis
of tuberous sclerosis.
02:04
That includes confetti lesions,
dental enamel pits,
intraoral fibromas,
retinal achromatic patch,
multiple renal cysts,
and nonretinal hamartomas.
02:14
Things you don't need to know
or memorize
but when you're seeing a patient,
or thinking of an vignette
about tuberous sclerosis,
you would want to research.