Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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September 29, 2014
Cytomegalovirus-Associated Ventriculitis and Chorioretinitis
- Radiographic findings of opportunistic cytomegalovirus (CMV) ventriculoencephalitis in the adult population are nonspecific.
- CMV retinitis and gastrointestinal tract involvement are common forms of CMV infection, but neurological manifestations appear in fewer than 1% of all patients with CMV infection.
- Clinical Presentation: Confusion, disorientation, apathy, withdrawal, cranial neuropathies, and nystagmus
- Ventriculoencephalitis is the most common form of CNS involvement in CMV infection and is characterized by ependymitis along the inner surface of ventricles.
- CMV-induced retinitis occurs in approximately one-third of patients with AIDS who are not receiving HAART, and accounts for more than 90% of cases of blindness related to HIV infection.
- Key Diagnostic Features:
- Diffusion restriction along the ependymal surface with/without contrast enhancement.
- Chorioretinitis manifests as uveal enhancement, retinal detachment, and calcifications in the retina.
- CMV-induced retinitis begins most commonly in one eye and progresses to involve the contralateral eye.
- Occasionally, findings related to cytotoxic edema from perivascular cuffing and thrombus formation can be seen.
- DDx:
- Lymphoma
- Pyogenic ventriculitis
- Rx: Antivirals. Without Rx, CMV-induced retinitis causes permanent blindness in most patients within 3–6 months.
