Neuro-Imaging Findings in Infants with Congenital Cytomegalovirus Infection: Relation to Trimester of Infection

Oosterom, Natanja; Nijman, Joppe; Gunkel, Julia; Wolfs, Tom F. W.; Groenendaal, Floris; Verboon-Maciolek, M A; Vries, Linda S. de

doi:10.1159/000375439

Cited by 48 publications

(35 citation statements)

References 25 publications

(35 reference statements)

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“…We believe that a rating scale is more helpful in categorizing the neurological risk. A recent retrospective study showed a relationship between the severity of neonatal neuroimaging and neurodevelopment in 36 infants with cCMV (26 symptomatic) [8]. All 5 patients with a normal US had a normal outcome, which is consistent with our and other studies [24], and 1 of 16 infants with mild US abnormalities (germinolysis and LSV) had polimicrogyria on MRI and a poor outcome.…”

Section: Discussionsupporting

confidence: 88%

“…Our data confirm that findings traditionally deemed as nonpathological [6], such as mild ventriculomegaly, LSV or caudothalamic germinolysis, do not rule out brain involvement and a risk of SNHL or other sequelae [6,8,22,23]. While a completely normal US (as performed and interpreted by a clinician with adequate expertise) is able to predict a good outcome, in cases with the abovementioned subtle changes, investigation of CNS involvement should be completed by MRI.…”

Section: Discussionsupporting

confidence: 87%

“…Neonatal neuroimaging predicts outcome in cCMV [2,3,4,5,6,7,8]. Furthermore, categorization of the severity of neuroimaging findings helps to determine prognosis in symptomatic cCMV [3,7].…”

Section: Introductionmentioning

confidence: 99%

“…CT entails exposure to ionizing radiation and it is not superior to ultrasound for the detection of abnormalities such as ventriculomegaly, subependymal pseudocysts, calcifications and lenticulostriate vasculopathy (LSV) [4,9]. Magnetic resonance imaging (MRI) plays a crucial role in the diagnosis of brain developmental disorders (namely cortical dysplasias and cerebellar hypoplasia) and white matter abnormalities [4,5,6,8,9,10]. However, scarce data on the relationship between neonatal cerebral ultrasound and MRI findings and neurodevelopmental outcomes in symptomatic cCMV are available.…”

Section: Introductionmentioning

confidence: 99%

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A Prognostic Neonatal Neuroimaging Scale for Symptomatic Congenital Cytomegalovirus Infection

et al. 2016

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Background: Congenital cytomegalovirus (cCMV) can cause brain inflammation/destruction and teratogenic effects. The only validated neuroimaging prognostic categorization for symptomatic cCMV available is based on destructive lesions seen on computed tomography (CT). Objective: The aim of this study was to establish the predictive ability of a comprehensive neonatal neuroimaging scale in symptomatic cCMV. Methods: Twenty-six infants were studied by neonatal cranial ultrasound scans (US; n = 25), CT (n = 11) and magnetic resonance imaging (MRI; n = 9). A previously validated neuroimaging scale comprising calcifications, ventriculomegaly and atrophy was compared to a newly proposed system adding cerebral dysgenesis and white matter disease. The findings were graded from 0 to 3. Neurodevelopmental assessment included motor and cognitive functions, epilepsy, vision, hearing and behavioral disorders. Results: Both scales showed a significant association with outcome (p < 0.005). Our scale was more accurate in predicting death or moderate-severe disability (area under the curve for scores ≥2, 0.88 ± 0.06 vs. 0.80 ± 0.08). All 5 infants with normal neuroimaging survived with intact neurological function. While our scale was highly associated with outcome in patients studied by MRI, it was unable to predict unfavorable outcomes in 2 patients with mildly abnormal US and/or CT. Conclusions: A comprehensive scale based on US and MRI predicts neurodevelopment in symptomatic cCMV. Significant destructive lesions are associated with a poor prognosis. While a strictly normal cranial US predicts a favorable outcome, in case of subtle US abnormalities, MRI is crucial for prognostication.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Prognostic Neonatal Neuroimaging Scale for Symptomatic Congenital Cytomegalovirus Infection

et al. 2016

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“…(10) kranyal ultrasonografinin nöronal migrasyon anomalilerini tespit etme oranının düşük olduğunu belirtmiştir. Ayrıca, yazarlar migrasyon anomalisi, periventrikü-ler kalsifikasyon, beyaz cevher kistleri, serebellar hipoplazi ve ventrikulomegali varlığını "ağır nöroradyolojik bulgular" olarak tanımlamışlar ve bu bulguların varlığının birinci trimester enfeksiyonuna ve yüksek mortaliteye işaret ettiğini belirtmişlerdir (10). Sunduğumuz olguda migrasyon anomalisinin kranyal ultrasonografi ile görüntülenebilmiş olması nörolojik hasarın ciddiyeti açısından anlamlıdır.…”

Section: Discussionunclassified

Neuronal Migration Anomaly in a Symptomatic Preterm Infant with Congenital Cmv Infection

Ünal¹,

Işık²,

Gural³

et al. 2017

Turkish J Pediatr Dis

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Konjenital CMV enfeksiyonunda santral sinir sitemine ait bulgular oldukça çeşitlidir. En sık mikrosefali, sensörinöral işitme kaybı, koryoretinit ve konvülziyon gelişmektedir. Ventrikülomegali-hidrosefali, periventriküler ekojenite artışı ve kalsifikasyon, beyaz cevher tutulumu ve lentikülostriat vaskülopati başta olmak üze-re nöroradyolojik bulgular olguların %70'inde saptanmaktadır. Nöronal migrasyon anomalileri, temporal kistik periventriküler lökomalazi, oksipital intraventriküler septa, serebral atrofi, korpus kallosum disgenezisi ve serebellar hipoplazi nadiren tespit edilmektedir (2). GİRİŞSitomegalovirüs (CMV) en sık konjenital enfeksiyon yapan etkendir. Sıklığı 0.2-2.4/1000 canlı doğum olarak tanımlanmak-tadır. Bulaş riski gebelik haftası ilerledikçe artmasına rağmen fetal hastalık ciddiyeti azalmaktadır. Gebeliğin erken döneminde enfekte olan fetusların %10-15'i doğumda semptomatik olup, olgularda intrauterin büyüme kısıtlanması, hepatosplenomegali, kolestaz, karaciğer fonksiyon testlerinde bozulma, pnömoni, pansitopeni, hemolitik anemi, peteşi, purpura, dermal eritropoez ve santral sinir sistemi bulgularının belirgin olduğu ağır sistemik hastalık tablosu görülmektedir (1). Konjenital Cmv Enfeksiyonun Prematürelerde Nadir Görülen ÖzETSitomegalovirüs en sık konjenital enfeksiyon yapan etkendir. Gebeliğin erken döneminde enfekte olan fetusların %10-15'i doğumda semptomatik olup, olgularda intrauterin büyüme kısıtlanması, hepatosplenomegali, kolestaz, karaciğer fonksiyon testlerinde bozulma, pnömoni, pansitopeni, hemolitik anemi, peteşi, purpura, dermal eritropoez ve santral sinir sistemi bulgularının belirgin olduğu ağır sistemik hastalık tablosu görülmektedir. Konjenital CMV enfeksiyonunda santral sinir sitemine ait bulgular oldukça çeşitli olup nöronal migrasyon anomalileri nadiren tespit edilmektedir. Burada ağır nöronal migrasyon anomalisinin ön planda olduğu konjenital sitomegalovirüs enfeksiyonu olan bir prematüre yenidoğan olgusu sunulmaktadır.Anahtar Sözcükler: Nöronal migrasyon anomalileri, Prematüre, Sitomegalovirüs, Yenidoğan AbstRActCytomegalovirus is the most common etiologic agent of congenital infections. If the fetus is infected by the virus in the first trimester of gestation, 10-15% of newborns present symptoms at birth. These symptomatic neonates exhibit a multisystem disease including intrauterine growth retardation, hepatosplenomegaly, cholestasis, impaired liver function tests, pneumonia, pancytopenia, hemolytic anemia, petechia, purpura, dermal erythropoiesis and central nervous system signs. Among the variable central nervous system findings, neuronal migration anomalies are infrequently identified in neonates. Herein, a premature neonate with neuronal migration anomaly due to congenital cytomegalovirus infection is presented.

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Hearing Instability in Children with Congenital Cytomegalovirus: Evidence and Neural Consequences

et al. 2022

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Objective/Hypothesis Sensorineural hearing loss (SNHL) is a common sequela of congenital cytomegalovirus (cCMV), potentially exacerbating neurocognitive delay. The objectives of this study were to assess: (1) age at which SNHL in children with cCMV; (2) stimulability of the auditory system in children with cCMV following cochlear implantation (CI); and (3) whether features of magnetic resonance imaging (MRI) potentially are predictive of hearing outcomes. Methods In this retrospective study of a prospectively acquired cohort, 123 children with cCMV who were referred for hearing loss at a single tertiary referral hospital over 20 years were compared with an unmatched comparative group of 90 children with GJB2‐related deafness. Outcome measures were results of newborn hearing screening (NHS), behavioral audiograms, and, in a subgroup of cochlear implant (CI) users, responses from the auditory nerve and brainstem evoked by CI at initial activation, as well as lesional volume of FLAIR‐hyperintense signal alterations on MRI. Results All but 3 of 123 children with cCMV had confirmed and persistent SNHL. At birth, 113 children with cCMV underwent NHS, 31 (27%) passed in both ears and 23 (20%) passed in one ear (no NHS data in 10 children). At the first audiologic assessment, 32 of 123 (26%) had normal hearing bilaterally; 35 of 123 (28%) had unilateral SNHL; and 57 of 123 (46%) had bilateral SNHL. More than half (67 of 123, 54%) experienced hearing deterioration in at least one ear. Survival analyses suggested that 60% of children who developed SNHL did so by 2.5 years and 80% by 5 years. In the children who passed NHS in one or both ears, 50% developed hearing loss by 3.5 years in the ear, which passed unilaterally (n = 23 ears), and 50% by 5 years in bilateral passes (n = 62 ears). Hearing loss was significant enough in all but one child with isolated high‐frequency loss for rehabilitation to be indicated. Hearing thresholds in individual ears were in the CI range in 83% (102 of 123), although duration of deafness was sufficient to preclude implantation at our center in 13 children with unilateral SNHL. Hearing aids were indicated in 16% (20 of 123). Responses from the auditory nerve and brainstem to initial CI stimulation were similar in children with cCMV‐related SNHL compared with GJB2‐related SNHL. Characteristic white matter changes on MRI were seen in all children with cCMV‐related SNHL (n = 91), but the lesion volume in each cortical hemisphere did not predict degree of SNHL. Conclusions cCMV‐related SNHL is often not detected by NHS but occurs with high prevalence in early childhood. Electrophysiological measures suggest equivalent stimulability of the auditory nerve and brainstem with CI in children with cCMV and GJB2‐related SNHL. Hyperintense white matter lesions on FLAIR MRI are consistently present in children with cCMV‐related SNHL but cannot be used to predict its time course or degree. Combined, the data show early and rapid deterioration of hearing in children with cCMV‐related SNHL with potential for...

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Neuro-Imaging Findings in Infants with Congenital Cytomegalovirus Infection: Relation to Trimester of Infection

Cited by 48 publications

References 25 publications

A Prognostic Neonatal Neuroimaging Scale for Symptomatic Congenital Cytomegalovirus Infection

A Prognostic Neonatal Neuroimaging Scale for Symptomatic Congenital Cytomegalovirus Infection

Neuronal Migration Anomaly in a Symptomatic Preterm Infant with Congenital Cmv Infection

Hearing Instability in Children with Congenital Cytomegalovirus: Evidence and Neural Consequences

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