Elsevier

Pediatric Neurology

Volume 15, Issue 3, October 1996, Pages 249-253
Pediatric Neurology

Case report
Late intrauterine Cytomegalovirus infection: Clinical and neuroimaging findings

https://doi.org/10.1016/S0887-8994(96)00170-1Get rights and content

Abstract

Fetal Cytomegalovirus (CMV) infection in early pregnancy usually results in severe neurological handicap and sensorineural hearing loss with typical neuroradiological findings of calcification, migrational anomalies, disturbed myelination, and cerebellar hypoplasia. Infections acquired in late pregnancy have less prominent signs, such as microcephaly, hearing deficits, and minor neurological handicap. We report 7 children who presented with a similar clinical complex of signs: microcephaly, sensorineural hearing impairment, behavior problems with hyperactivity, reduced apprehension for pain in 5 of the 7, ataxia in 3, and hypotonia with clumsiness in 3 others. All manifested mild to severe developmental problems. Cranial CT revealed calcification in 4 of 6 patients. MRI in all 7 children showed patchy to confluent nonprogressive dysmyelination. Only 2 children had acute neonatal signs of congenital CMV infection. We assume that these children acquired CMV infection in the third trimester of gestation, leading to microcephaly, hearing loss, and neurological and developmental problems with typical neuroradiological signs.

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    Intrauterine transmission has been reported to occur in all trimesters with the highest rates in the second trimester (Enders et al., 2011; Pass et al., 2006). Similar to other congenital infections, the severity of central nervous system (CNS) damage has been linked to intrauterine transmission in late, first and early second trimester, although congenital HCMV infections resulting in long term sequelae have been reported following maternal infection in the third trimester (Enders et al., 2011; Pass et al., 2006; Stagno et al., 1986; Steinlin et al., 1996). About 10% of congenitally infected infants will have clinical symptoms that include microcephaly, hepatosplenomegaly, petechial rashes, neurological abnormalities such as altered tone and seizures, intrauterine growth restriction, and rarely extramedullary hematopoiesis.

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