Neuroimaging of Pediatric Central Nervous System Cytomegalovirus Infection

Abstract

Cytomegalovirus (CMV) is a ubiquitous virus that usually results in asymptomatic or clinically benign infection. However, there are two groups of patients whose response to CMV infection is much more severe: those who are infected during fetal development and those who are immunocompromised. Although the manifestations of these types of infection differ, both often result in substantial neurologic sequelae. Imaging plays a key role in the diagnosis of both congenital and acquired CMV infection. Neurologic findings of congenital CMV infection include intracranial calcification, migrational abnormalities, cerebral and cerebellar volume loss, ventriculomegaly, and white matter disease. The presence of these findings in children with neurodevelopmental delays is suggestive of congenital CMV infection, even if the child was asymptomatic at birth. Certain imaging features also may indicate future neurologic deficits in symptomatic infants. Acquired CMV infection is potentially deadly in immunocompromised patients such as those infected with human immunodeficiency virus or with acquired immune deficiency syndrome and those with a history of solid organ or bone marrow transplantation. Imaging findings of acquired CMV infection often are nonspecific; however, they may indicate a need for further serologic analysis to determine if CMV infection is present. Early recognition and treatment of central nervous system CMV infection is vital for effective treatment, and familiarity with the imaging findings of this common infection is important for accurate diagnosis.

Presumed Zika virus-related congenital brain malformations: the spectrum of CT and MRI findings in fetuses and newborns

“…The distribution of calcifications (basal ganglia, periventricular, and in the cortical and subcortical white matter junctions) seen in our patients is similar to the pattern described in cytomegalovirus infection, although the latter more commonly affects the periventricular region and the former the cortical and subcortical white matter junctions 15,24 . The only available methodology at the time of examination for a presumptive diagnosis of ZIKV infection was the negativity of serology for those agents already known, besides the positive epidemiological history of rash during pregnancy.…”

Global Developmental Delay in a Mexican Patient With Megalencephalic Leukoencephalopathy With Subcortical Cysts

“…The differences with MLC are based on clinical evolution, neuroimaging, and biochemical findings (13,14).…”

Assessment of the diagnostic reliability of brain CT and MRI in pediatric epilepsy patients

“…Calcification is commonly thick and chunky, commonly seen in periventricular regions but may occur in basal ganglia and brain parenchyma. Congenital CMV infection is also characterized by cerebral atrophy and ventriculomegaly (35). A variety of associated migrational abnormalities like lissencephaly, pachygyria, and polymicrogyria have been reported (36).…”