Congenital cytomegalovirus

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[edit] Discussion

-Cytomegalovirus (CMV) is a DNA virus in the herpesvirus family.

-It is the most common cause of intrauterine infection and brain damage, occuring in 0.2-2.2% of live births.

-30%-60% of pregnant women have CMV antibodies, but only 2.5% have primary infection during pregnancy.

-The virus is transmitted from the mother to the fetus in utero via the placenta.

-90% of infected babies are asymptomatic at birth, but some may go on to develop symptoms after 6-9 months. Some countries now keep spots of neonatal blood on special filter paper (Guthrie cards) for CMV DNA testing at a later date if needed.

[edit] Possible signs and symptoms

The degree of neurological impairment is variable, from mild learning and behavioral problems to mental retardation and physical handicaps

[edit] Imaging Findings

[edit] Head CT

  • Intracranial calcifications
  • White matter lucencies
  • Ventriculomegaly
  • Destructive encephalopathy
  • Atrophy
  • Neuronal migration disorders

[edit] MR

  • Dilated ventricles
  • Subarachnoid space enlargement and gyral abnormalities
  • Delayed myelination
  • White matter lesions

[edit] US

Fetal CMV is usually undetected by routine transabdominal ultrasound, but prenatal transvaginal screening ultrasound in infected mothers may show:

  • Periventricualr calcifications (hyperechogenic foci)
  • Hydrocephalus
  • Heterogeneous appearing parenchyma
  • Microcephaly
  • Intraventricular adhesions

These findings are associated with poor outcome, allowing mothers to consider termination of the pregnancy.

[edit] Images

Patient #1

[edit] See Also

[edit] External Links

[edit] References

  • Van der Knaap M, et al. 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. 2004 Feb;230(2):529-36.
  • Kapilivsky A, et al. US case of the day. Congenital cytomegalovirus (CMV) brain infection. Radiographics. 1995 Jan;15(1):239-42.
  • Malinger G, et al. Fetal cytomegalovirus infection of the brain: the spectrum of sonographic findings. AJNR Am J Neuroradiol. 2003 Jan;24(1):28-32.

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