Skip to main content

Advertisement

SpringerLink
Log in

Brain magnetic resonance findings in symptomatic congenital cytomegalovirus infection

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Congenital cytomegalovirus (CMV) infection can lead to severe neurological sequelae, but a defined brain magnetic resonance (MR) pattern and MR predictors of clinical outcome are still lacking.

Materials and methods

Clinical and MR findings of 14 children with symptomatic congenital CMV infection were retrospectively reviewed.

Results

Microcephaly, cerebral palsy and epilepsy were found in eight, six and seven patients, respectively (all concomitant in 6); 12 children developed sensory-neural hearing loss (SNHL). At first MRI (mean age 21 months, range 5–54 months), white matter (WM) involvement was not assessable in two children due to incomplete myelination. WM abnormalities were common (11/12 patients); deep WM was predominantly involved in 5/11; the largest WM lesion was in the parietal lobe in 6/11. Anterior temporal lobe abnormalities were found in 13/14. Six children underwent MRI examination after 2 years of life; in this subgroup, WM abnormalities were extensive and confluent (4/6), bilateral and multifocal (1/6) or absent (1/6). Four children showed a progression of myelination. Ventriculomegaly (9/14), migration disorders (6/14 polymicrogyria and 1/14 pachygyria-lissencephaly) and hippocampal dysplasia (6/14) correlated with severe neurological sequelae (p < 0.05, Fisher exact test), while the presence of WM abnormalities (11/12), periventricular cysts (6/14) and cerebellar hypoplasia (4/14) did not predict the outcome.

Conclusions

The spectrum of brain MR abnormalities in symptomatic congenital CMV infection is extremely wide. WM involvement is variable, difficult to evaluate at a very young age and unrelated to clinical outcome, while cortical malformations, ventriculomegaly and hippocampal dysplasia seem to be strong predictors of poor outcome except for SNHL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Boppana SB, Stagno S, Pass RF et al (1992) Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality. Pediatr Infect Dis J 11:93–99

    Article  PubMed  CAS  Google Scholar 

  2. Ivarsson S-A, Lernmark B, Svanberg L (1997) Ten-year clinical, developmental, and intellectual follow- up of children with congenital cytomegalovirus infection without neurologic symptoms at one year of age. Pediatrics 99:800–803

    Article  PubMed  CAS  Google Scholar 

  3. Pass RF, Stagno S, Myers GJ et al (1980) Outcome of symptomatic congenital cytomegalovirus infection: results of long-term longitudinal follow-up. Pediatrics 66:758–762

    PubMed  CAS  Google Scholar 

  4. Stagno S (2001) Cytomegalovirus. In: Remington JS, Klein JO (eds) Infectious diseases of the fetus and newborn infant, 5th edn. Saunders, Philadelphia, pp 389–424

    Google Scholar 

  5. Fowler KB, Stagno S, Pass RF et al (1992) The outcome of congenital cytomegalovirus infection in relation to maternal antibody status. N Engl J Med 326:663–667

    Article  PubMed  CAS  Google Scholar 

  6. Crumpacker CS (2000) Cytomegalovirus. In: Mandell GM, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, 5th edn. Churchill Livingstone, Philadelphia, pp 1586–1599

    Google Scholar 

  7. Behrman RE (1997) Il feto e il neonato. In: Giovannini M (ed). Trattato di pediatria Nelson, 15th edn. Minerva Medica, Torino, pp 539–540

  8. Barbi M, Binda S, Caroppo S et al (2003) A wider role for congenital cytomegalovirus infection in sensorineural hearing loss. Pediatr Infect Dis J 22:39–42

    Article  PubMed  Google Scholar 

  9. Williamson WD, Demmler GJ, Percy AK et al (1992) Progressive hearing loss in infants with asymptomatic congenital cytomegalovirus infection. Pediatrics 90:862–866

    PubMed  CAS  Google Scholar 

  10. Boppana SB, Fowler KB, Vaid Y et al (1997) Neuroradiographic findings in the newborn period and long-term outcome in children with symptomatic congenital cytomegalovirus infection. Pediatrics 99:409–414

    Article  PubMed  CAS  Google Scholar 

  11. Noyola DE, Demmler GJ, Nelson CT et al (2001) Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection. J Pediatr 138:325–331

    Article  PubMed  CAS  Google Scholar 

  12. Barkovich AJ, Lindan CE (1994) Congenital cytomegalovirus infection of the brain: imaging analysis and embryologic considerations. Am J Neuroradiol 15:703–715

    PubMed  CAS  Google Scholar 

  13. De Vries LS, Gunardi H, Barth PG et al (2004) The spectrum of cranial ultrasound and magnetic resonance imaging abnormalities in congenital cytomegalovirus infection. Neuropediatrics 35:113–119

    Article  PubMed  Google Scholar 

  14. van der Knaap MS, Vermeulen G, Barkhof F et al (2004) Pattern of white matter abnormalities at MR imaging: use of polymerase chain reaction testing of Guthrie cards to link pattern with congenital cytomegalovirus infection. Radiology 230:529–536

    Article  PubMed  Google Scholar 

  15. Ross SA, Boppana SB (2004) Congenital cytomegalovirus infection: outcome and diagnosis. Semin Pediatr Infect Dis 16:44–49

    Article  Google Scholar 

  16. van der Knaap MS (2005) Myelination and retarded myelination. In: Magnetic resonance of myelination and myelin disorders, 3rd edn. Springer, pp 40–41

  17. Kenneson A, Cannon MJ (2007) Review and meta-analysis of the epidemiology of congenital cytomegalovirus infection. Rev Med Virol 17:253–276

    Article  PubMed  Google Scholar 

  18. Nelson CT, Demmler GJ, Istas AS et al (1993) Early prediction of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection. Pediatr Res 39:180A

    Article  Google Scholar 

  19. Salmaso R, Franco R, de Santis M et al (2007) Early detection by magnetic resonance imaging of fetal cerebral damage in a fetus with hydrops and cytomegalovirus infection. J Matern Fetal Neonatal Med 20:559–561

    Article  PubMed  CAS  Google Scholar 

  20. Doneda C, Parazzini C, Righini A et al (2010) Early cerebral lesions in cytomegalovirus infection: prenatal MR imaging. Radiology 255:613–621

    Article  PubMed  Google Scholar 

  21. Benoist G, Salomon LJ, Mohlo M et al (2008) Cytomegalovirus-related fetal brain lesions: comparison between targeted ultrasound examination and magnetic resonance imaging. Ultrasound Obstet Gynecol 32:900–905

    Article  PubMed  CAS  Google Scholar 

  22. Benoist G, Salomon LJ, Jacquemard F et al (2008) The prognostic value of ultrasound abnormalities and biological parameters in blood of fetuses infected with cytomegalovirus. BJOG 115:823–829

    Article  PubMed  CAS  Google Scholar 

  23. Guerra B, Simonazzi G, Puccetti C et al (2008) Ultrasound prediction of symptomatic congenital cytomegalovirus infection. Am J Obstet Gynecol 198:380.e1–380.e7

    Article  Google Scholar 

  24. Steinlin MI, Nadal D, Eich GF et al (1996) Late intrauterine cytomegalovirus infection: clinical and neuroimaging findings. Pediatr Neurol 15:249–253

    Article  PubMed  CAS  Google Scholar 

  25. Barkovich AJ (2005) Infections of the nervous system. In: Barkovich AJ (ed) Pediatric neuroimaging, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 802–806

    Google Scholar 

  26. Boesch J, Issakainen J, Kewitz G et al (1989) Magnetic resonance imaging of the brain in congenital cytomegalovirus infection. Pediatr Radiol 19:91–93

    Article  PubMed  CAS  Google Scholar 

  27. Sugita K, Ando M, Makino M et al (1991) Magnetic resonance imaging of the brain in congenital rubella virus and cytomegalovirus infection. Neuroradiology 33:239–242

    Article  PubMed  CAS  Google Scholar 

  28. Lopez-Pison J, Rubio-Rubio R, Ureña-Hornos T et al (2005) Diagnóstico retrospectivo de infección congenital por citomegalovirus en un caso clínico infantile. Rev Neurol 40:733–736

    PubMed  CAS  Google Scholar 

  29. O'Rourke D, Bradley L, King MD et al (2010) Leukoencephalopathy with anterior temporal cysts due to congenital CMV infection diagnosed retrospectively. J Neuroimaging 20:292–293

    Article  PubMed  Google Scholar 

  30. Tatli B, Ozmen M, Aydinli N et al (2005) Not a new leukodystrophy but congenital cytomegalovirus infection. J Child Neurol 20:525

    PubMed  Google Scholar 

  31. Suzuki Y, Toribe Y, Mogami Y et al (2008) Epilepsy in patients with congenital cytomegalovirus infection. Brain Dev 30:420–424

    Article  PubMed  Google Scholar 

  32. Guibaud L, Attia-Sobol J, Buenerd A et al (2004) Focal sonographic periventricular pattern associated with mild ventriculomegaly in foetal cytomegalic infection revealing cytomegalic encephalitis in the third trimester of pregnancy. Prenat Diagn 24:727–732

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Chiara Briani, M.D., for helpful comments in the preparation of this manuscript.

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Neuroradiology Unit, University Hospital of Padua, Via Giustiniani 2, 35128, Padua, Italy

    Renzo Manara

  2. Department of Pediatrics, University of Padua, Padua, Italy

    Laura Balao & Paola Drigo

  3. Department of Neurological Sciences, University of Padua, Padua, Italy

    Claudio Baracchini

  4. Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Padua, Padua, Italy

    Ruggiero D’Elia & Ezia Maria Ruga

Authors
  1. Renzo Manara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Balao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudio Baracchini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paola Drigo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ruggiero D’Elia
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ezia Maria Ruga
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Renzo Manara.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Manara, R., Balao, L., Baracchini, C. et al. Brain magnetic resonance findings in symptomatic congenital cytomegalovirus infection. Pediatr Radiol 41, 962–970 (2011). https://doi.org/10.1007/s00247-011-2120-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-011-2120-5

Keywords

Search

Navigation