Cytomegalovirus Infection

Neurologic diseases associated with cytomegalovirus infection are more often encountered in immunocom-promised—particularly HIV-infected—patients. The infection is acquired by exposure to infected saliva or respiratory secretion, transfusion, and possibly by sexual contact. Fetuses are infected by transplacental transmission and, neonates are infected by feeding with infected breast milk.

Acute infections have a broad spectrum of clinical-pathological presentations: aseptic meningitis; encephalitis characterized by presence of microglial nodules; ventriculitis, often necrotizing with calcifications; radiculomyelitis and radiculoneuropathy (Guillain-Barré syndrome); and retinitis. The virus may infect the glial cells, ependymal cells, neurons, and vascular endothelial cells. The infected cells enlarge and contain intranuclear (owl's-eye) and, less often, intracy-toplasmic inclusions (Fig. 6.11).

Congenital and neonatal CMV infections cause microcephaly, mental retardation, seizures, hearing impairment, chorioretinitis, and cerebral malformations (see Chapter 13).

CT scan of the head displays punctate subependy-mal calcifications. Contrast-enhanced CT and MRI display the subependymal lining of the ventricles. MRI is useful in demonstrating associated malformations.

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