Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

QUIZ
Year
: 2006  |  Volume : 16  |  Issue : 4  |  Page : 943--944

Radiological quiz - neuroradiology


I Ahmad, F Haque, S Wahab, U Ahmad 
 D/ O Prof . Abdul Wahab, Kashana e Wahab, Street No. 4 , Iqra Colony, Near Iqra Public School, New Sir Syed Nagar , Aligarh - 202002, India

Correspondence Address:
S Wahab
D/ O Prof . Abdul Wahab, Kashana e Wahab, Street No. 4 , Iqra Colony, Near Iqra Public School, New Sir Syed Nagar , Aligarh - 202002
India




How to cite this article:
Ahmad I, Haque F, Wahab S, Ahmad U. Radiological quiz - neuroradiology.Indian J Radiol Imaging 2006;16:943-944


How to cite this URL:
Ahmad I, Haque F, Wahab S, Ahmad U. Radiological quiz - neuroradiology. Indian J Radiol Imaging [serial online] 2006 [cited 2020 Aug 14 ];16:943-944
Available from: http://www.ijri.org/text.asp?2006/16/4/943/32393


Full Text

A 7 month old infant presented with frequent episodes of seizures , delayed developmental milestones and petechial rash . The infant was born prematurely at 33 weeks of gestational age . Physical examination revealed petechial rash and hepatosplenomegaly . Haematological investigations revealed thrombocytopenia and atypical lymphocytosis . Liver function test of the infant was deranged with conjugated hyperbilirubinemia and elevated alanine aminotransferase levels . CT Scan Brain was done [Figure 1][Figure 2].

What is your diagnosis ?

 Radiological Diagnosis



 View AnswerCONGENITAL CMV INFECTION ( CYTOMEGALIC INCLUSION DISEASE )

CT Scan Brain shows widespread bilateral parenchymal calcifications particularly in the periventricular regions with cortical atrophy , ventricular prominence and diffuse hypodensity of periventricular white matter .

 Discussion



Cytomegalovirus is the most common cause of congenital infections [1].

Cytomegalic inclusion disease develops in 5 % of infected fetuses and is seen almost exclusively in infants born to mothers who develop primary infection during pregnancy [2] . There may be μ) a fatal infection of fetus involving viscera μμ ) a baby may be born with residual neurological damage or μμμ ) there may be mild disease with only serological and virological evidence of disease [3].

Fetal infection may occur at any age of gestation . Infants infected with CMV may be born before term . Congenital disease is characterized by thrombocytopenic purpura , hepatosplenomegaly, jaundice and chorioretinitis . Seizures , mental retardation , hydrocephalus , deafness and optic atrophy are later manifestations [4].

Imaging studies ( CT / MRI ) : Features of cytomegalovirus inclusion disease include

non specific ventricular enlargement , cortical atrophy and parenchymal particularly periventricular calcification . Delayed myelination and neuronal migration anomalies may be seen [5]. In newborns with symptomatic Congenital Cytomegalovirus ( CMV ) infection , neuroimaging is the best available predictor of neurodevelopmental outcome [6].

The diagnosis of CMV infection is based on isolation of the virus or detection of CMV antigens or DNA from white blood cells , urine , throat or conjuctival swabs . CMV specific Ig M detection may help in the diagnosis of recent infection . Ganciclovir is the drug of choice , however the prognosis is poor and death rate is high.[7]

References

1Osborn AG : Infections of the Brain and its linings . In Diagnostic Neuroradiology , pp 674 . Mosby Elseviers Pub 1994 .
2Hirsch MS : Cytomegalovirus and Human Herpes Virus Types 6 ,7and 8 in Harrison's Principles of Internal Medicine Editors Kasper DL , Braunwald E , Fauci AS et al , pp 1049 - 53 , Vol I 16 th edition Mc Graw Hill Pub 2005 .
3Ghai OP , Gupta P , Paul VK : Cytomegalic Inclusion Virus Disease in Essential Pediatrics pp 139 fifth edition Mehta Pub 2001
4Shaw DWW , Cohen WA : Viral infections of the CNS in children : Imaging features, AJR 160 , 125 - 133 , 1993 .
5Haginoya K , Ohura T , Kon K et al : Abnormal white matter lesions with sensorineural hearing loss caused by Congenital Cytomegalovirus Infection : retrospective diagnosis by PCR using Guthrie cards in Brain and Development Oct 24 ( 7 ) 710 - 14 : Elsevier Science BV 2002 .
6Barkovich AJ , Lindan CE : Congenital Cytomegalovirus Infection of the brain : imaging analysis and embryologic considerations , Am J Neuroradiol . Apr , 15 ( 4 ) : 703 - 15 , 1994 .
7Bopanna SB , Fowler KB , Vaid Y et al : Neuroradiographic features in the newborn period and longterm outcome in children with symptomatic Congenital Cytomegalovirus Infection in Paediatrics Mar 99 ( 3 ) : 409 - 14 , 1997.