Tuberous sclerosis is a neurocutaneous syndrome characterized by a clinical spectrum varying from severe mental retardation and incapacitating seizures to normal intelligence and lack of seizures, often within the same family(1). The younger the patients present with symptoms and signs of TSC (tuberous sclerosis complex), the greater are the likelihood of mental retardation (2). Skin features are very characteristic of the disease and help in the early diagnosis of the disease. Shagreen patch is one of the major diagnostic features of the disease. It is a less common skin lesion consisting of an excess amount of fibrous tissue similar to that found in scar tissues (3). It is a section of thickened, elevated pebbly skin like an orange peel. The name is derived from the French phrase “peau chagrinee”. It is usually found on the lower back, buttock, thigh and the nape of the neck commonly. In this case report we report a characteristic skin lesion, the shagreen patch in a six-year-old child with TSC at an unusual site (the cheek) never reported before with the best of our knowledge.

Children suffering from Cerebral Palsy (CP), exhibit movement limitations and physiological abnormalities as compared to normal individuals.The objective of this study was to assess mechanical efficiency and certain cardiovascular indices before and after an exercise-rehabilitation program in children with dipelegia spastic cerebral palsy (experimental group) in comparison with able-bodied children(controls).In this study, 15 spastic cerebral palsy (dipelegic) children participated in an exercise-rehabilitation program, three days a week for three months with an average 144bpm of heart rate. The mechanical efficiency (net, gross), rest and submaximal heart rate and maximal oxygen consumption(VO2max) weremeasured before (pretest) and after (posttest) exercise program on the cycle ergometer according to the Macmaster ergometer protocol. Then control group, of 18 normal children underwent the exercise program and were assessed, following which results of the 2 groups were compared using SPSS for statistical analysis (P<0.05).Mechanical efficiency (net, gross) increased significantly in CP patients after the exercise-rehabilitation program; reults did not alter significantly for the controls.Rest and submaximal heart rate in CP patients decreased significantly after exercise program. Maximal oxygen consumption, which remained unchanged in patients following the exercise program, was similar in patients and controls after the program.Cerebral palsy patients, because of their high muscle tone, severe degree of spasticity, and involuntary movements are physically more incapacitated and need more energy than normal able-bodied individuals.Rehabilitation and aerobic exercise can be effective in improving their cardiovascular fitness and muscle function and increasing their mechanical efficiency.