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(A) Antenatal ultrasound at 38 weeks of gestation. Dilation of the occipital horn of both lateral ventricles, with the left lateral ventricle larger than the right (white arrow), is shown. Strands are visible in the ventricle. An echogenic left choroid and an adjacent inhomogeneous area suggestive of a blood clot (black arrow) are also visible. (B) Axial T1 MRI showing well-septated bilateral posterior occipital cysts (black arrows), a subependymal cyst anterior to the left caudothalamic groove (white arrow), and asymmetry of the anterior horns of the lateral ventricle. (C) Axial T2 MRI showing a collection of blood in the dependent area of the left lateral ventricle (white arrow) separated from the occipital cyst by a thin limiting membrane.
Source publication
Intraventricular hemorrhage with congenital cytomegalovirus (CMV) infection is rare and has been reported only in extremely
premature infants or in association with thrombocytopenia. We report the first case of a full-term male infant with congenital
CMV infection and intraventricular hemorrhage with a normal platelet count and coagulation profile....
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Pathophysiology of retinopathy of prematurity (ROP) still presents a gap. Lately blood tests parameters of premature infants have been measured at different times of ROP, attempting to detect correlations with ROP development and progression. So far, very early post-natal biomarkers, predictive of ROP outcome, have not been detected. Our purpose is...
Citations
... Suksumek et al. [14] reported a case of term neonate with congenital CMV infection and intraventricular hemorrhage with a normal platelet count and coagulation profile. It was diagnosed later in pregnancy at 38 weeks of gestation, in a baby without growth retardation. ...
Cytomegalovirus (CMV) is the most common cause of congenital infection, with a wide spectrum of clinical manifestations and different grade of severity. We report the case of a male baby born at term with an early prenatal diagnosis of severe intracranial hemorrhage (ICH), with no other evident risk factors. Urine and blood sample were testedfor CMV-DNA, and diagnosis of congenital CMV infection was established. This case describes intracranial hemorrhage as uncommon although possible sign of early fetal CMV infection. Considering that pathogenic factors cannot be defined in 25% of term neonates with ICH, this case report highlights the importance of CMV screening in pregnant women and in term infants with prenatal ICH of unknown origin.
... This report is suggestive of a direct effect of CMV on the developing vasculature; in fact, even if the most frequent outcomes of CMV congenital infections are polymicrogyria, cortical dysplasia, and neuronal migration disorders [116,117], the occurrence of neonatal brain bleedings has been reported [118]. CMV can infect ECs of the brain [108] and induce in the fetus vasculitis that can evolve and manifest as thrombosis, coagulopathy, or hemorrhage even in the absence of thrombocytopenia [111,119,120]. Vasculopathies are also a common complication associated with human immunodeficiency virus (HIV) infections [121], for which the NVU is believed to constitute the main brain route access. ...
Intragravidic and perinatal infections, acting through either direct viral effect or immune‐mediated responses, are recognized causes of liability for neurodevelopmental disorders in the progeny. The large amounts of epidemiological data and the wealth of information deriving from animal models of gestational infections have contributed to delineate, in the last years, possible underpinning mechanisms for this phenomenon, including defects in neuronal migration, impaired spine and synaptic development, and altered activation of microglia. Recently, dysfunctions of the neurovascular unit and anomalies of the brain vasculature have unexpectedly emerged as potential causes at the origin of behavioral abnormalities and psychiatric disorders consequent to prenatal and perinatal infections. This review aims to discuss the up‐to‐date literature evidence pointing to the neurovascular unit and brain vasculature damages as the etiological mechanisms in neurodevelopmental syndromes. We focus on the inflammatory events consequent to intragravidic viral infections as well as on the direct viral effects as the potential primary triggers. These authors hope that a timely review of the literature will help to envision promising research directions, also relevant for the present and future COVID‐19 longitudinal studies.
... Cytomegalovirus DNA PCR was positive, although platelet count, coagulogram, and liver function were normal, and bleed was attributed directly to the pathological effects of the virus. 6 Ayadi and Ben Hamida reported a term neonate, with no abnormality detected on antenatal ultrasound, who was found to have thrombocytopenia and bilateral subependymal cysts and hydrocephalous. Polymerase chain reaction was positive for CMV; however, liver function test was normal. ...
Intraventricular hemorrhage is an uncommon manifestation of congenital cytomegalovirus (CMV) infection and has been described in preterm neonates. We discuss a term neonate, who was referred because of intracranial hemorrhage and hydrocephalous detected in the antenatal ultrasound. She had cholestatic jaundice, hepatitis, and thrombocytopenia, with positive polymerase chain reaction for CMV. Neuroimaging revealed reduced sulcation, mildly enlarged ventricles, and multiple periventricular cysts, along with residual hemorrhage in occipital horn of left lateral ventricle. She was started on ganciclovir, following which there was improvement in platelet count, jaundice, as well as transaminase levels.
... Similar to the case in the report of Suksumek et al., our patient was a full-term baby from a physiological delivery without thrombocytopenia, but with IVH after birth. [10] It should therefore be considered, if an isolated IVH in the CNS in a full-term infant, without delivery complications or abnormalities in the coagulation system, should provide an indication for diagnostics for CCMV. It seems to be important because intraventricular bleeding is found in 3.5% of infants and, in 25% of these cases, pathogenic factors cannot be defined. ...
Congenital Cytomegalovirus infection (CCMV) is the most common intrauterine infection. Early diagnosis of CCMV is hindered by three factors: There is no screening programme for CMV infection in pregnant women; a high percentage of infections in neonates are asymptomatic; the clinical signs of CCMV infection are uncharacteristic. The aim of this article is to analyse the clinical picture and course of CCMV treatment in a 3-week-old newborn, analyse adverse events in 14-week-long antiviral therapy and also assess intraventricular bleeding as an early indicator for the diagnosis of CCMV.
... Hemorragia intraventricular y quistes subependimarios han sido informados como únicas manifestaciones de infección congénita por CMV en recién nacidos a término 37 . ...
... Detection of intracranial bleeding in that setting is unlikely to influence pregnancy management but will, at least, reassure the mother that the recurrence risk is low in future pregnancies. [29][30][31] Recent work has identified genetic mutations that may predispose to ICH. 32 ...
... In cytomegalovirus infection, temporal lobe destruction results in a characteristic distribution of intraparenchymal cystic lesions. 18,29 Porencephalic cysts are associated with severe developmental delay and seizure disorders due to the underlying brain destruction (Figures 5 and 6). Arachnoid cysts are simple in architecture and, unless associated with mass effect or other brain malformation, have no adverse impact on the infant. ...
Ventriculomegaly (VM) is a nonspecific finding on fetal imaging. Identification of the specific etiology is important as it affects prognosis and may even change the course of current or future pregnancies. In this review we will focus on the application of fetal MRI to demonstrate intracranial hemorrhage (ICH) and ischemic brain injury as opposed to other causes of VM. MRI is able to identify the specific etiology of ventriculomegaly with much more sensitivity and specificity than ultrasound and should be considered whenever VM is identified on obstetric ultrasound. Advances in both fetal and neonatal MRI have the potential to shed further light on mechanisms of brain injury and the impact of chronic hypoxia; such information may guide future interventions.
... Even though initially he had no neurological symptoms, cranial ultrasound on day 5 of life showed heterogeneous, echogenic bilateral masses within the ventricular system indicative of bilateral germinal matrix hemorrhage; magnetic resonance imaging (MRI) at the age of 2 months revealed hyperintensity on fluid attenuated inversion recovery sequences were suggestive of white matter rarefaction and cystic degeneration. 5,6 Liver involvement presented initially as nonspecific hepatitis associated with cholestasis that worsened over the first month of life with the highest level of direct bilirubin 181 µmol/L. He was successfully managed with ursodiol, Omegaven (Fresenius Kabi AG, Bad Homburg, Germany), phenobarbital, and vitamins A, D, E, and K. Hepatobiliary iminodiacetic acid scan revealed mild-to-moderate excess of blood pool activity that indirectly confirmed hepatic dysfunction secondary to CMV hepatitis. ...
Background Cytomegalovirus (CMV) is one of the most common causes of serious viral intrauterine infections. It is universally distributed among the human population with an average incidence of 0.15 to 2%. Indeed, at least half of the women in the reproductive age have evidence of prior CMV infection.
Epidemiology and Pathogenicity However, it is not a usual practice to screen asymptomatic pregnant woman or neonates for CMV. Even if a mother developed a primary CMV infection during pregnancy, up to 90% of the newborns with congenital CMV will be asymptomatic at the time of birth. Only 5 to 7% of the infected babies will be acutely symptomatic, and the typical clinical presentation includes intrauterine growth restriction, microcephaly, various cutaneous manifestations (including petechiae and purpura), hematological abnormalities (particularly resistant thrombocytopenia), hepatosplenomegaly, chorioretinitis, hepatitis, etc. In contrast, acquired CMV infection is extremely unlikely to cause any serious sequelae for the infant.
Cases We present a case of congenital and acquired CMV infection in twins with a focus of dissimilarity in presentation, clinical course, and outcome.
... Los mecanismos mediante los cuales se genera el sangrado todavía no están claros, aunque este podría deberse a un freno medular producido por el virus en los precursores eritroides o megacariocíticos. Algunos investigadores consideran que por su naturaleza neurotrópica el virus causa daño directo de las neuronas y las células endoteliales, produciendo una vasculitis que afecta los vasos sanguíneos y el sistema nervioso central (12). Como se ha dicho, la infección por citomegalovirus con sangrado del sistema nervioso central es poco frecuente; solo se han reportado algunos casos clínicos en fetos y nunca en infecciones adquiridas (6,(12)(13)(14)(15). ...
... Algunos investigadores consideran que por su naturaleza neurotrópica el virus causa daño directo de las neuronas y las células endoteliales, produciendo una vasculitis que afecta los vasos sanguíneos y el sistema nervioso central (12). Como se ha dicho, la infección por citomegalovirus con sangrado del sistema nervioso central es poco frecuente; solo se han reportado algunos casos clínicos en fetos y nunca en infecciones adquiridas (6,(12)(13)(14)(15). ...
Cytomegalovirus is the most frequent causative agent of perinatal infection and a major cause of acquired viral infections. This case report aims to show the broad clinical spectrum of the presentation of cytomegalovirus infection. The correct classification of congenital or acquired infection and its prompt treatment can prevent complications and sequelae in severe cases. We report the case of an infant with acquired cytomegalovirus infection, which presented an unusual feature of cerebral hemorrhage. The patient was treated with ganciclovir, with a favorable evolution of the clinical symptoms. Cytomegalovirus infection is common in children, both in its congenital and acquired forms. Acquired infection, as portrayed in this case, is mainly characterized by hematological compromise given by the marked thrombocytopenia, which may rarely result in cases of bleeding in the central nervous system. In this patient, no important clinical implications occurred. In addition, most of the acquired infections are self-limited and require no treatment.
... Los mecanismos mediante los cuales se genera el sangrado todavía no están claros, aunque este podría deberse a un freno medular producido por el virus en los precursores eritroides o megacariocíticos. Algunos investigadores consideran que por su naturaleza neurotrópica el virus causa daño directo de las neuronas y las células endoteliales, produciendo una vasculitis que afecta los vasos sanguíneos y el sistema nervioso central (12). Como se ha dicho, la infección por citomegalovirus con sangrado del sistema nervioso central es poco frecuente; solo se han reportado algunos casos clínicos en fetos y nunca en infecciones adquiridas (6,(12)(13)(14)(15). ...
... Algunos investigadores consideran que por su naturaleza neurotrópica el virus causa daño directo de las neuronas y las células endoteliales, produciendo una vasculitis que afecta los vasos sanguíneos y el sistema nervioso central (12). Como se ha dicho, la infección por citomegalovirus con sangrado del sistema nervioso central es poco frecuente; solo se han reportado algunos casos clínicos en fetos y nunca en infecciones adquiridas (6,(12)(13)(14)(15). ...
El citomegalovirus es el agente de infección perinatal más frecuente y una de las principales causas de infecciones virales adquiridas. En la presentación del siguiente caso se describe el amplio espectro clínico de la infección por citomegalovirus. La clasificación correcta de la infección como congénita o adquirida y el tratamiento oportuno pueden evitar complicaciones y secuelas en los casos graves.
Se describe el caso de un lactante menor que presentaba una infección por citomegalovirus con la manifestación poco frecuente de hemorragia cerebral. Después del tratamiento con ganciclovir, los síntomas clínicos evolucionaron favorablemente. La infección por citomegalovirus es muy frecuente en la edad pediátrica, tanto en la forma congénita como en la adquirida. La forma adquirida, como la de este caso, se caracteriza principalmente por el compromiso hematológico, al producirse una importante trombocitopenia, lo que puede originar, aunque infrecuentemente, sangrado del sistema nervioso central; la mayoría de las infecciones adquiridas, sin embargo, son de resolución espontánea y no requieren tratamiento. En este paciente no se presentaron repercusiones clínicas de importancia.
