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Published on: July 24, 2016
A unique brain germinal matrix involvement in cytomegalovirus infected fetuses: A retrospective neurosonographic
Roee Birnbaum1,2, Adi Winsteen1,2, Michael Brusilov1,2
1OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Objective:
To study the clinical significance of brain germinal matrix (GM) changes in cytomegalovirus (CMV) infected fetuses.
Method:
This is a retrospective analysis. Group A; isolated GM finding, with or without lenticulostriatal vasculopathy (LSV). Group B; non-isolated lesion. Amniocentesis, urinalysis, postnatal US and developmental assessment, were obtained.
Results:
Group A and B included 18 and four fetuses, respectively. In group A, mean fetal age at diagnosis was 34.3 weeks (31-38 weeks). In 15/18 (83.3%), the lesion was bilateral and LSV was present in 8/18 (44.4%). Small cysts appeared inside the lesion in 5/18 (27.7%). MRI was normal in 8/18 (44.4%). Subtle or inconclusive findings were reported in the remaining fetuses. Brain ultrasound was normal in 10/18 (55.5%) of newborns. In the remaining, caudothalamic cyst with or without LSV, or isolated LSV were found. All newborns are developing normally at a mean follow-up age of 33.3 months (+/- 19.6 moths). In group B, all four patients requested for termination of pregnancy.
Conclusion:
Fetal CMV infection may cause focal GM changes, frequently accompanied by LSV, late in pregnancy. These changes may be isolated, or as part of a more generalized brain damage. When isolated, favorable prognosis is expected.
Insights
Isolated brain germinal matrix (GM) changes in fetuses infected with cytomegalovirus (CMV) often indicate a favorable prognosis. However, widespread damage suggests a poorer outcome, highlighting the importance of careful assessment.
Area of Science:
- Neonatal Neurology
- Fetal Medicine
- Infectious Diseases
Background:
- Cytomegalovirus (CMV) infection is a common cause of congenital infections.
- Germinal matrix (GM) and intraventricular hemorrhage are known complications of fetal CMV.
- The clinical significance of isolated GM changes in fetal CMV requires further elucidation.
Purpose of the Study:
- To investigate the clinical significance of fetal brain germinal matrix (GM) changes in cases of cytomegalovirus (CMV) infection.
- To differentiate outcomes based on the presence and extent of GM lesions.
Main Methods:
- Retrospective analysis of fetuses with confirmed CMV infection.
- Classification into Group A (isolated GM findings +/- lenticulostriatal vasculopathy) and Group B (non-isolated lesions).
- Inclusion of amniocentesis, urinalysis, postnatal ultrasound, and developmental assessments.
Main Results:
- Group A (18 fetuses) showed isolated GM changes, often bilateral with lenticulostriatal vasculopathy (LSV), and typically diagnosed late in pregnancy.
- Newborns in Group A with isolated GM changes demonstrated normal development at follow-up.
- Group B (4 fetuses) with non-isolated lesions resulted in pregnancy termination.
Conclusions:
- Fetal CMV infection can manifest as focal GM changes, frequently associated with LSV, particularly in late pregnancy.
- Isolated GM changes in fetal CMV infection are associated with a favorable neurodevelopmental outcome.
- Non-isolated or generalized brain damage in fetal CMV infection carries a poor prognosis, often leading to termination.
