CNS damage in Cytomegalovirus infection - clinics and diagnosis

Abstract

Background. Congenital cytomegalovirus (CMV) infection is a leading non-genetic cause of sensorineural hearing loss and neurodevelopmental impairment in children. CNS involvement greatly impacts morbidity. This study reviews clinical features, diagnostic methods, and neuroimaging findings in pediatric patients. Objective(s). This study aims to review and analyze the clinical features, diagnostic tools, and neuroimaging findings of CNS damage due to congenital CMV in children to enhance diagnosis and management. Materials and methods. A systematic review was conducted through PubMed, Embase, and Cochrane databases from 2000 to 2024. Pediatric patients (<18 years) with confirmed CMV infection were included. Data were extracted on neurological manifestations, CSF findings, neuroimaging features (USG, MRI), and diagnostic tools including PCR and serology. Results. Across 32 studies encompassing 5,217 pediatric patients with CMV infection, CNS involvement was noted in 38–75% of symptomatic neonates. Clinical features included microcephaly (45%), seizures (28%), hypotonia (35%), and developmental delay (52%). MRI findings predominantly showed periventricular calcifications, ventriculomegaly, migrational abnormalities, and cerebral atrophy. CSF PCR demonstrated high specificity (>90%) for CMV detection. Neonates with abnormal neuroimaging had significantly lower cognitive and motor scores on follow-up. Sensitivity of dried blood spot PCR for early diagnosis was 84%, while urine CMV PCR remained gold standard. Conclusion(s). Congenital CMV infection has a significant risk on CNS damage and neurodevelopmental deficits. Early diagnosis using clinical evaluation, neuroimaging, and PCR is vital for better outcomes. Standardized neurodevelopmental monitoring protocols are essential to improve prognosis and guide treatment.