Miller Derryl J, Davis Jade, Gervelis Whitney, Singhal Saurabh, Conrad Susan
Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Child Neurology, South Bend Child Neurology, South Bend, IN, USA.
Radiol Case Rep. 2025 May 12;20(8):3689-3692. doi: 10.1016/j.radcr.2025.04.053. eCollection 2025 Aug.
A previously healthy 2-month-old male presented with fever and seizures. Cerebrospinal fluid (CSF) studies, head computed tomography (CT), and brain magnetic resonance imaging (MRI) studies were unremarkable on admission. After a clinical decline on the second day admission due to cerebral edema a repeat head CT showed loss of gray-white matter differentiation indicative of global anoxic injury. A repeat brain MRI on day 5 revealed diffuse restricted diffusion globally, acute infarction of the right posterior inferior cerebellar artery territory, and left frontoparietal leptomeningitis versus cortical laminar necrosis. A repeat LP was done on day 5 and showed a total nucleated cell count of 42 cells/mm^3 with 39% lymphocytes and 61% monocytes, glucose 52 mg/dL. He made steady clinical improvement with supportive care. CMV was detected on the repeat CSF sample using PCR on day 11 and he was started on ganciclovir for CMV meningoencephalitis. CMV should be considered as an etiology for viral meningoencephalitis even in immunocompetent patients. Our case also shows the classic imaging evolution of CMV meningoencephalitis.
一名此前健康的2个月大男性出现发热和惊厥。入院时脑脊液（CSF）检查、头部计算机断层扫描（CT）和脑磁共振成像（MRI）检查均无异常。入院第二天因脑水肿临床病情恶化，复查头部CT显示灰白质分界消失，提示全脑缺氧损伤。第5天复查脑MRI显示全脑弥漫性扩散受限、右后下小脑动脉区域急性梗死以及左额顶叶软脑膜炎与皮质层状坏死。第5天再次进行腰椎穿刺，结果显示总核细胞计数为42个细胞/mm³，其中淋巴细胞占39%，单核细胞占61%，葡萄糖为52mg/dL。经支持治疗，他的临床病情稳步改善。第11天在复查的脑脊液样本中通过聚合酶链反应（PCR）检测到巨细胞病毒（CMV），遂开始使用更昔洛韦治疗CMV脑膜脑炎。即使在免疫功能正常的患者中，CMV也应被视为病毒性脑膜脑炎的病因之一。我们的病例还展示了CMV脑膜脑炎典型的影像学演变过程。
