Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Resident : Ensi Khalili Pouya
Gender : Male
Age : 0
10 days old baby boy with episodes of drop oxygen saturation and poor feeding
CT scan without contrast in axial view demonstrates periventricular punctate calcification with different sizes.
1-CMV infection 2-toxoplasmosis
Discussion (Related Text)
Toxoplasma is a protozoan parasite causing transplacental infection (toxoplasmosis) of the human fetus during or after the 3rd fetal month, and is the third most common fetal brain infection after CMV and HIV. Cats are the terminal host with oocysts excreted in feline feces. Maternal risk factors include exposure to cat excreta during pregnancy, or eating raw, previously unfrozen meat. Contaminated water supply has been linked to one outbreak. The maternal infection is usually asymptomatic, although involvement of the CNS occurs in approximately half of infected fetuses. The rate of infection increases with each trimester, while the actual severity of the infection decreases. Hydrops fetalis, ascites, pleural and pericardial effusions and hydrocephalus may be seen on fetal sonography. While neonates may be symptomatic at birth with clinical features similar to congenital CMV, they are usually asymptomatic. An important differentiating feature would be the head size, as neonates with congenital CMV are commonly microcephalic, while those with congenital toxoplasmosis are more likely to have hydrocephalus. Release of Toxoplasma from cysts leads to an intense inflammatory reaction and granulomatous necrosis. Progressive hydrocephalus occurs in association with turbid, proteinaceous CSF, ependymitis and subsequent aqueductal obstruction. Marked expansion of the atria of the lateral ventricles is common in patients with Toxoplasma-related hydrocephalus. Neuronal migration anomalies are not commonly seen, although delayed myelin maturation is seen on imaging. Basal ganglia and periventricular calcifications are common, may be seen even in asymptomatic children, and may even disappear over time without treatment. Chorioretinitis is extremely common, and may lead to progressive visual loss in otherwise asymptomatic children. Treatment in utero is available and improves outcome; treatment during the first year of life also improves neurological outcome.
Mary R. MRI of the Neonatal Brain. Part 4, Chapter 1, Neonatal brain infections.