Pediatric Cytomegalovirus Encephalitis

  • Etiology: transplacental infection of CMV
  • Imaging:
    — If infection is early – before 18 weeks – see migration anomaly (lissencephaly), polymicrogyria, cerebellar hypoplasia
    — If infection is late – see destructive lesions, germinolysis, myelination delay
    — Large ventricles due to encephalomalacia, periventricular calcifications + lenticulostriate calcifications, intraparenchymal hemorrhage, microcephaly
  • Clinical: pneumonia, hepatosplenomegaly, blueberry muffin lesions on skin = petechia, purpura, mounded lesions of extramedullary hematopoesis

Radiology Cases of Cytomegalovirus Encephalitis (Early Infection)

MRI of CMV / cytomegalovirus encephalitis
Axial T1 MRI without contrast of the brain (left) shows gyral thickening compatible with pachygyria and ventriculomegaly. Axial T2 MRI (right) shows increased bright signal throughout the white matter, compatible with delayed myelination. There are also several areas of punctate low signal along the periphery of the lateral ventricles posteriorly, compatible with foci of calcification, which were confirmed on GRE images (not provided).
MRI of diffuse polymicrogyria in a patient with cytomegalovirus encephalitis
Axial T2 MRI without contrast of the brain show thickening and abnormal sulcation of the perirolandic gray matter diffusely bilaterally. There is also evidence of perisylvian fissure syndrome bilaterally.