engleski

Cortical malformations in children with cerebral palsy caused by congenital cytomegalovirus infection.

INTRODUCTION: Congenital cytomegalovirus (cCMV) infection is the most common vertically transmitted infection. Fetal infection occurring in early pregnancy results in severe neurological sequelae, while later infection has less prominent signs. METHODS: We present nine patients with cortical malformations and cerebral palsy caused by cCMV infection. Motor functions and accompanying impairments were evaluated according to Surveillance of Cerebral Palsy in Europe (SCPE) recommendations. RESULTS: According to MRI results we assume that all of our children were infected during first trimester. Five of our children with lissencephaly/pachygyria had very early onset of infection. The other four with less severe cortical dysplasia in form of polymicrogyria were probably infected relatively later. Results of cerebellar hypoplasia (3 children) and calcifications (2 children) also confirm an early onset of infection. Most of the children had bilateral spastic cerebral palsy (7/8) and only one had dyskinetic, subtype dystonic. Gross motor function was severely affected in majority of children ; according to GMFCS, 3 children had level I-III and 6 level V (wheelchair dependant). All children had some level of intellectual impairment (1 mild, 1 moderate, 7 severe). Speech difficulties were classified using the VIKING speech scale ; in 2 children speech was severely affected (level 3) and 7 children had no understandable speech (level 4). Epilepsy was found in 8/9 of children. Visual impairment was present in 8/9 children and 4 of them had severe visual impairment. Hearing impairment was present in 3 children and it was classified as severe in 2 of them. CONCLUSION: Congenital CMV infection causes multiorgan affection, but the most severe sequelae are those affecting central nervous system. Radiological findings in our study mostly showed lissencephaly/pachygyria, polymicrogyria, calcifications and/or cerebellar hypoplasia that can indicate early and important impact of CMV infection on neurogenesis.

cortical malformations, cerebral palsy, congenital cytomegalovirus infection

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