Congenital CMV infection
Known congenital cytomegalovirus (CMV) infection. New vacant episodes, intermittent visual disturbance. No new neurology on examination.
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Deep white matter hyperintensities, predominantly in the parietal and right temporal lobes. These spare the immediate subcortical matter/U-fibres. Dedicated seizure sequences not performed but no gross migrational abnormality. Normal posterior fossa. Normal midline structures and brainstem. No abnormal restricted diffusion.
Normal CSF configuration. Normal expected vascular flow voids.
Microcephaly. Normal skull base and craniocervical junction.
2 case question available
This patient has known congenital CMV infection, confirmed on serology, urine, throat swab and PCR testing. Mother had a flu-like illness in the first trimester.
As a term baby, she presented with abdominal distention and hepatosplenomegaly, with developmental motor delay as she progressed.
Previous MRIs (from age 1) display similar findings to this study, with white matter changes predominantly in posterior structures and microcephaly. Other findings in congenital CMV infection can include: periventricular/temporal subcortical cysts, delayed myelination, migrational abnormalities, increased CSF spaces.
Congenital CMV is the most common of the congenital "TORCH" infections.