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A child with Hirschsprung disease, severe intellectual disability, and absent speech has distinctive facies with widely spaced eyes, broad nasal bridge, and uplifted earlobes.

AD (de novo); ZEB2 gene

  • Distinctive facies: hypertelorism, broad nasal bridge, uplifted earlobes, pointed chin
  • Hirschsprung disease (~50%)
  • Intellectual disability (severe), absent/limited speech
  • Seizures, microcephaly
  • Congenital heart defects, genitourinary anomalies
  • Clinical recognition of the distinctive facies with severe intellectual disability, often with Hirschsprung disease
  • Molecular confirmation by ZEB2 sequencing and deletion/duplication analysis (most variants are de novo)
  • Suction rectal biopsy to confirm Hirschsprung disease; echocardiogram, renal ultrasound, and brain MRI (corpus callosum)
  • Surgical management of Hirschsprung disease; ongoing bowel and constipation management
  • Antiseizure medication for epilepsy; developmental, speech, and physical therapy
  • Cardiology, nephrology/urology, and ophthalmology surveillance for associated anomalies
  • Genetic counseling: typically de novo with low recurrence risk (germline mosaicism reported)

"Mow the Mohawk": Microcephaly, Open-mouth expression, Widely-spaced eyes, absent corpus callosum, Transcription factor mutation (ZEB2), weight down (growth restriction), Hirschsprung's & hypospadias, epilepsy, heart defects, kidney defects

"Zero Exit from Bowels in ZEB2": Hirschsprung disease (absent ganglion cells in colon) occurs in ~50% of patients.

Mowat-Wilson "Mow-Hawk" mnemonic
Mowat-Wilson "Mow-Hawk" mnemonic

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