Congenital CMV Infection Presenting With Massive Intracerebral Hemorrhage

Presentor

Dr Robert Hammond is a Neuropathologist at London Health Sciences Centre and a Professor of Pathology and Clinical Neurological Sciences at Western University in the Schulich School of Medicine and Dentistry.

Authors

Barbra deVrijer 1, Diana Crowley 2, Delaney Cosma 2, Giulio Muscedere 3 and Robert Hammond 2, 4 1 Department of Obstetrics and Gynaecology 2 Department of Pathology and Laboratory Medicine 3 Department of Medical Imaging 4 Department of Clinical Neurological Sciences Schulich School of Medicine & Dentistry, Western University, London Health Sciences Centre and St Joseph’s Health Care, London, Ontario, Canada

CanMEDS: Medical Expert (the integrating role), Communicator, Health Advocate, Scholar

Description Cytomegalovirus (CMV) is among the most common of intrauterine infections against which we have no effective preventative or therapeutic options. The developing nervous system is a frequent target of CMV and while most injuries are subclinical, severe insults leading to microcephaly and migration defects are well known. A 20-week gestational age fetus was found to have several abnormalities on prenatal ultrasound, the most prominent of which was a large echogenic focus in one cerebral hemisphere. Congenital CMV infection was identified by amniocentesis and maternal serology. The pregnancy was ended by early induction of labour for a 368g stillborn infant. Postmortem examination revealed massive intracerebral hemorrhage as the correlate for the sonographic finding. The microscopic examination of the brain was also striking for extensive polymicrogyria, a high burden of CMV and abundant angiocentric CMV pathology. Catastrophic intracerebral hemorrhage has not been previously reported in association with congenital CMV infection. The present case expands the range of potential injuries the developing brain is subject to in the setting of CMV infection and raises the possibility of a direct vascular injury.