Original article
Congenital cytomegalovirus infection and cortical/subcortical malformations
Citomegalia congénita y malformaciones corticales y subcorticales
Read
8156
Timeswas read the article
1240
Total PDF
6916
Total HTML
Share statistics
array:25 [ "pii" => "S2173580812001186" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2012.07.013" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "aid" => "332" "copyright" => "Sociedad Española de Neurología" "copyrightAnyo" => "2011" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2012;27:336-42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3897 "formatos" => array:3 [ "EPUB" => 76 "HTML" => 3133 "PDF" => 688 ] ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S0213485312000187" "issn" => "02134853" "doi" => "10.1016/j.nrl.2011.12.017" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "aid" => "332" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2012;27:336-42" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 10465 "formatos" => array:3 [ "EPUB" => 65 "HTML" => 9273 "PDF" => 1127 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Citomegalia congénita y malformaciones corticales y subcorticales" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "336" "paginaFinal" => "342" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Congenital cytomegalovirus infection and cortical/subcortical malformations" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3434 "Ancho" => 1643 "Tamanyo" => 480864 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caso 5. Paciente de 6 meses. A) Corte axial de la RM a la altura de la base cerebral mostrando amplia zona de hiperseñal en sustancia blanca de ambos hemisferios. B) Corte coronal del mismo estudio en T2. Se observan alteraciones corticales e hiperseñalización difusa de la sustancia blanca, con predominio en zonas posteriores y anteriores del cerebro.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Pascual-Castroviejo, S.I. Pascual-Pascual, R. Velazquez-Fragua, J. Viaño Lopez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Pascual-Castroviejo" ] 1 => array:2 [ "nombre" => "S.I." "apellidos" => "Pascual-Pascual" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Velazquez-Fragua" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Viaño Lopez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580812001186" "doi" => "10.1016/j.nrleng.2012.07.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580812001186?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485312000187?idApp=UINPBA00004N" "url" => "/02134853/0000002700000006/v1_201305151149/S0213485312000187/v1_201305151149/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2173580812001162" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2012.07.011" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "aid" => "327" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2012;27:343-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3612 "formatos" => array:3 [ "EPUB" => 62 "HTML" => 2740 "PDF" => 810 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Movement analysis of upper extremity hemiparesis in patients with cerebrovascular disease: A pilot study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "343" "paginaFinal" => "347" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis del movimiento de la extremidad superior hemiparética en pacientes con accidente cerebrovascular: estudio piloto" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 656 "Ancho" => 2003 "Tamanyo" => 180690 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(A) From the initial position, the subject begins the capture process by moving the hand to the cup. (B) Subject captures the cup, (C) subject lifts the cup to the lips, (D) subject returns the cup to the table and (E) subject releases the cup and the hand resumes its initial position.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Molina Rueda, F.M. Rivas Montero, M. Pérez de Heredia Torres, I.M. Alguacil Diego, A. Molero Sánchez, J.C. Miangolarra Page" "autores" => array:6 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Molina Rueda" ] 1 => array:2 [ "nombre" => "F.M." "apellidos" => "Rivas Montero" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Pérez de Heredia Torres" ] 3 => array:2 [ "nombre" => "I.M." "apellidos" => "Alguacil Diego" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Molero Sánchez" ] 5 => array:2 [ "nombre" => "J.C." "apellidos" => "Miangolarra Page" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485312000138" "doi" => "10.1016/j.nrl.2011.12.012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485312000138?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580812001162?idApp=UINPBA00004N" "url" => "/21735808/0000002700000006/v1_201305151336/S2173580812001162/v1_201305151336/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2173580812001150" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2012.07.010" "estado" => "S300" "fechaPublicacion" => "2012-07-01" "aid" => "324" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 0 "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2012;27:330-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 13385 "formatos" => array:3 [ "EPUB" => 83 "HTML" => 12259 "PDF" => 1043 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Cerebellar infarction: Prognosis and complications of vascular territories" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "330" "paginaFinal" => "335" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infarto cerebeloso: pronóstico y complicaciones de sus territorios vasculares" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 674 "Ancho" => 2182 "Tamanyo" => 120787 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Distribution in percentages linking degree of disability at discharge (left) and at 3 months (right) with the affected territory.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.M. Cano, P. Cardona, H. Quesada, P. Mora, F. Rubio" "autores" => array:5 [ 0 => array:2 [ "nombre" => "L.M." "apellidos" => "Cano" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Cardona" ] 2 => array:2 [ "nombre" => "H." "apellidos" => "Quesada" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Mora" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Rubio" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485312000102" "doi" => "10.1016/j.nrl.2011.12.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213485312000102?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580812001150?idApp=UINPBA00004N" "url" => "/21735808/0000002700000006/v1_201305151336/S2173580812001150/v1_201305151336/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Congenital cytomegalovirus infection and cortical/subcortical malformations" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "336" "paginaFinal" => "342" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Pascual-Castroviejo, S.I. Pascual-Pascual, R. Velásquez-Fragua, J. Viaño López" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Pascual-Castroviejo" "email" => array:1 [ 0 => "i.pcastroviejo@neurologia.e.telefonica.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S.I." "apellidos" => "Pascual-Pascual" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Velásquez-Fragua" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Viaño López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neurología Pediátrica, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Imagen, Hospital del Rosario, Madrid, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Citomegalia congénita y malformaciones corticales y subcorticales" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3433 "Ancho" => 1641 "Tamanyo" => 436313 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Case 5: Patient aged 6 months. (A) MR axial section at level of the base of the brain showing a wide hyperintense zone in the white matter on both hemispheres. (B) T2-weighted coronal section of the same study. Note the cortical abnormalities and diffuse hyperintensity in the white matter, predominantly in the posterior and anterior areas of the brain.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Malformations of cortical development (MCDs) are classified within a large group of neuronal migration and cortical organisation disorders. The most well-known entities of this type are schizencephaly, lissencephaly-pachygyria, polymicrogyria, cortical dysplasia, and heterotopia.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Interest in these entities resides in the fact that each one is linked to neurological problems, which mainly include epileptic seizures, mental retardation, and motor or sensory alterations. MCDs arise from changes in neuronal migration, cortical organisation, and the histological structure of neurons due to disturbances in the normal differentiation processes for neurons and glial cells in the ependymal germinal matrices of the lateral ventricles.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> The formative process is followed by the processes by which brain cells undergo differentiation, migrate, and take up their correct locations as directed by specific genes.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Some genes are more important than others; the reelin gene directs the process.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However, the aetiologies of some types of MCDs cannot always be identified, and linking them to a specific gene is harder still. According to some authors, early onset exogenous lesions, such as hypoxia, infections during gestation, or perinatal trauma, may play a part in the development of certain types of MCDs.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–9</span></a> In an experimental model, cortical dysplasia was also induced in rats with altered neuronal morphology and cortical development caused by exposure to radiation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Cytomegaly is an enlargement of cells, particularly one caused by cytomegalovirus. This virus is the most common cause of intrauterine and perinatal viral infections in the world, and affects more than 40<span class="elsevierStyleHsp" style=""></span>000 children yearly in the United States alone.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a> The TORCH infections (toxoplasmosis, rubella, cytomegalovirus, and herpes) have not been listed among the typical intrauterine and perinatal infections for many years now. Differential diagnosis is used to rule them out, especially through use of analytical markers, which are mostly haematological, immunological, or biochemical. Even so, the term is still commonly used among paediatricians, especially neonatal paediatricians. Although diagnostic capacities have increased with the early application of new imaging methods using intrauterine techniques, such as computed tomography (CT) and MRI,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11–14</span></a> many infants continue to be born with the sequelae of intrauterine cytomegalovirus. Their clinical symptoms include jaundice, thrombocytopenia, hepatomegaly, petechiae, purpura, and splenomegaly. Nearly half of all cases present complications of the CNS including microcephaly, uveitis, sensory hearing loss, intracranial calcifications, delayed psychomotor development, and seizures.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> It seems that only minor advances in treatment have been made. The vaccine which inspired so much hope more than 30 years ago now delivers better results than it once did, and is used in preventing mother-to-child transmission.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> However, gains from this treatment are still a topic for debate.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Our study contained 6 patients whose mothers were infected with cytomegalovirus during pregnancy, causing MCD (schizencephaly, lissencephaly-pachygyria and polymicrogyria), in addition to changes in white matter signals accompanied by severe neurological symptoms in the fetuses. Patients therefore underwent neurological and radiological study after birth, and were subsequently treated.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The group of 6 patients examined by the paediatric neurology department at Hospital Universitario La Paz contained 4 females and 2 males. Age at time of examination was neonate (NN) to 9 months (mean age 3 months); patients were seen due to convulsions, microcephaly, spasticity, delayed psychomotor development, and deafness. All of the patients’ mothers had given birth for the first or second time and more than 50% had experienced fever, abdominal pain, or high erythrocyte sedimentation rate during pregnancy. All births were normal and full-term. Apgar scores at 1<span class="elsevierStyleHsp" style=""></span>min were 9/10; infants weighed between 2700 and 2850<span class="elsevierStyleHsp" style=""></span>g and had head circumferences of 32 to 33<span class="elsevierStyleHsp" style=""></span>cm. One patient presented with a bilateral ear infection which required drainage until it resolved a few months later. In addition to analytical tests run to determine the link between the syndrome and infection with cytomegalovirus, postnatal MR studies were performed in 5 patients, using different sequences and cortical surface reconstruction. We performed these studies because lesions caused by the virus often lead to polymicrogyria, pachygyria, and schizencephaly. The only imaging study performed in one case was CT.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The MR studies performed on the mothers of 2 patients showed no abnormalities.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">Increases in head circumference were below the level of <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>−2 SD. Among the 3 patients who do not have schizencephaly and are still seen periodically, this remained the case at the time of the last check-up, when these patients were between 8 and 12 years old. The other 3 patients presented very severe delays in psychomotor development, and all were lost to follow-up during the first year of life due to the family's abandoning treatment; during that time, patients failed to consciously interact with their environment and were obviously unable to speak or sit up. Delays in reaching all psychomotor milestones were also significant in the three patients without schizencephaly. They began walking and talking very late; 2 demonstrate very basic walking and language ability, which was achieved through a regimen of speech therapy and physical therapy with intramuscular botulinum toxin injections to combat the patients’ spasticity. One is still unable to walk without assistance due to spasticity, which causes hip subluxation (case 4).</p><p id="par0035" class="elsevierStylePara elsevierViewall">In this case (the only case in which a CT study was performed, <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), both the CT and complete MR studies showed significant alterations in both subcortical white matter and subcortical grey matter. Bilateral open-lipped schizencephaly (BOLS) was present in cases 1 and 2, with unilateral schizencephaly in case 3. Cases 4, 5, and 6 displayed polymicrogyria with areas of pachygyria in both hemispheres. These alterations were observed in all of the projections or slices (axial, coronal, and sagittal) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) in all sequences taken in cases 4, 5, and 6. There were no differences between the alterations recorded during the first year of life and those at 6 to 10 years. This stabilisation process for cortical lesions did not occur in white matter lesions. T2-weighted hyperintense MR images of white matter lesions evolved during the early years at the very least; in later years, an abnormality was still apparent and the signal was not completely normal (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3–5</a>). These T2-weighted hyperintense areas became more isolated, but they did continue to appear for a few years. These areas were interpreted as a possible manifestation of delayed myelination. However, we cannot rule out a chronic inflammatory reaction due to attack by cytomegalovirus, since infection is followed by neurological sequelae that affect nearly all CNS functions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Images of the ventricles in patients with schizencephaly were very different; they were extremely dilated, with hemispheric schizencephalic clefts in BOLS cases (1 and 2) or unilateral clefts (case 3). The septum pellucidum and the corpus callosum were absent in all 3 of these cases. The polymicrogyric edges of the schizencephalic clefts do not show up clearly in any of the images from these patients. One patient underwent study with CT only; in the others, MR imaging was not 3D, which is the only method for capturing a well-defined image of this anomaly. In the 3 patients with lissencephaly-pachygyria or polymicrogyria, the lateral ventricles appear dilated and rounded. This is probably due to white matter atrophy.</p><p id="par0045" class="elsevierStylePara elsevierViewall">EEGs repeatedly showed some kind of focal alteration whose appearance varied depending on whether or not seizures were controlled at the time. Seizure control was achieved with pharmacological treatment in the 3 patients (cases 4–6) who were monitored over a number of years. The most relevant clinical, EEG, and imaging findings appear in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Intrauterine infection by cytomegalovirus is very likely the most common infection causing malformations in fetuses.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Both the mothers and the children affected by the infection during gestation and the neonatal period showed the typical signs of the infection. These signs include hepatosplenomegaly, microcephaly, hearing disorders, uveitis, petechiae, delayed psychomotor development, and seizures.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15–19</span></a> Until the advent of RM studies, which can be used to directly diagnose the main fetal brain abnormalities caused by cytomegalovirus, the imaging techniques used for diagnostic purposes were simple radiology and pneumoencephalography, which shows periventricular calcifications and microcephaly.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Unlike toxoplasmosis, another TORCH complex entity (in this case, parasitic) which creates immunity, cytomegalovirus is not eliminated after the first infection in most cases. Rather, it remains latent and may reactivate at a later time, especially in patients who are immunocompromised or pregnant. This is what occurred in 75% of the cases.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Infection by cytomegalovirus occurs in 0.6%–0.7% of all neonates and it is the most common congenital neurological condition of infectious origin in both Spain<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and Sweden, where its prevalence is between 0.2% and 0.5%. Malformations of the cerebral cortex are its most severe sequelae.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,22</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Children who show symptoms during the neonatal period are at high risk of presenting neurological sequelae at a later date. Many infants who appear to be normal at birth begin to display an array of mostly neurological abnormalities and others such as hearing disorders. These are often associated with white matter lesions, which may be extensive and appear early,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> as demonstrated by cases 4, 5, and 6 in our series.</p><p id="par0070" class="elsevierStylePara elsevierViewall">One of the most reliable tests for detecting primary infection is the presence of IgG and IgM immunoglobulin. For a few years now, it has been possible to diagnose cytomegalovirus retrospectively by using polymerase chain reaction techniques on the DNA of blood stored on Guthrie test cards.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23–25</span></a> Intrauterine detection is not difficult, but treatment provides only limited results, and the most promising current treatment consists of administering antibiotics and steroids to the mother.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Absence of abdominal signs during gestation guarantees the survival of the affected infants. The presence of abdominal or brain signs is associated with poor prognosis, which brings up the possibility of administering intrauterine treatment to fetuses with cytomegalovirus infections.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The presence of microcephaly and typical ocular lesions in a newborn, or delayed psychomotor development, hyperactivity, lack of motor coordination, hearing loss, and signs of cerebellar impairment in an older patient, indicate late-onset infection with intrauterine cytomegalovirus.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> MR studies of the brain lesions show, in addition to decreased brain mass and generalised ventricular dilation, changes in the grey and white matter. In the grey matter, we see changes in the shape of the sulci and gyri, with schizencephaly, lissencephaly, polymicrogyria, pachygyria, and cortical dysplasia.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,22,25,28–30</span></a> These types of cortical abnormalities depend on the moment in gestation in which the fetus was affected by cytomegalovirus.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> These abnormalities do not normally present alone, but are accompanied by similarly severe lesions in the cerebellum, such as global hypoplasia affecting the vermis and the cerebellar hemispheres.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The mechanism by which cytomegalovirus affects the cerebral parenchyma is quite controversial. Prevalent theories include affinity of the virus for germinal matrix cells and the vascular impairment which the virus causes in the fetus.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres169960" "titulo" => array:5 [ 0 => "Abstract" 1 => "Introduction" 2 => "Material and methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec158033" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres169959" "titulo" => array:5 [ 0 => "Resumen" 1 => "Introducción" 2 => "Material y métodos" 3 => "Resultados" 4 => "Conclusión" ] ] 3 => array:2 [ "identificador" => "xpalclavsec158034" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-12-12" "fechaAceptado" => "2011-12-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec158033" "palabras" => array:5 [ 0 => "Cytomegaly" 1 => "Encephalopathy due to cytomegaly" 2 => "Schizencephaly" 3 => "Lissencephaly-pachygyria due to cytomegaly" 4 => "Polymicrogyria due to cytomegaly" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec158034" "palabras" => array:5 [ 0 => "Citomegalia" 1 => "Encefalopatía por citomegalia" 2 => "Esquisencefalia" 3 => "Lisencefalia-paquigiria por citomegalia" 4 => "Polimicrogiria por citomegalia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Intrauterine infection due to cytomegalovirus is the most common of the intrauterine viral/parasitic infections that affect the central nervous system (CNS) and cause permanent lesions in the cortex as well as the subcortical white matter. Studies using brain magnetic resonance imaging (MRI) are limited.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Six patients (4 females and 2 males) were studied in the first months of life in order to make a diagnosis of congenital cytomegalovirus, and identify the cortical and subcortical lesions using the necessary MRI sequences.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The six patients showed malformations of cortical development (MCD) (schizencephaly, polymicrogyria or lissencephaly-pachygyria) from the neonatal period, and diffuse changes of the white matter, which remained with few changes during the first two years. They then began reducing in size in the form of high signal areas in T2, restricted to certain areas, and were evident for a few years more with little change.</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intrauterine infection due to cytomegalovirus causes changes in the cortical grey matter, which consists of MCD, and in the subcortical white matter. The latter show a changing aspect as they appear as diffuse and wide areas of high signal intensity, which is usually due to delay in myelinisation, but could also be caused directly by the cytomegalovirus. These changes in the white matter are subjected to morphological changes throughout the first years of life, leading to brain atrophy. The neurological sequelae of these lesions left by these alterations are severe and chronic.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La infección intrauterina por citomegalovirus es la más frecuente de las viriasis/parasitosis intrauterinas que afectan al sistema nervioso central y causan lesiones permanentes tanto en el córtex como en la sustancia blanca subcortical. Son escasos los estudios de resonancia magnética (RM) cerebral.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Seis pacientes (4 M y 2 V) fueron estudiados desde los primeros meses de vida para hacer el diagnóstico de citomegalia congénita e identificar la presencia de lesiones corticales y subcorticales, utilizando las necesarias secuencias de RM.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los 6 pacientes mostraban malformaciones del desarrollo cortical (MDC) (esquisencefalia, polimicrogiria o lisencefalia-paquigiria) desde la época neonatal y alteraciones difusas de la sustancia blanca, que se mantuvieron con pocos cambios durante los dos primeros años y después se iban reduciendo de tamaño en forma de zonas de hiperseñal en T2, circunscritas a determinadas áreas y permanecían con pocos cambios durante algunos años más.</p> <span class="elsevierStyleSectionTitle">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La infección intrauterina por citomegalovirus causa lesiones en sustancia gris cortical, que consisten en MCD y en sustancia blanca subcortical. Estas últimas muestran aspecto cambiante, ya que aparecen como áreas difusas y amplias de hiperseñal, que se suelen interpretar como retraso en la mielinización, pero que también pueden ser causadas directamente por el virus de la citomegalia. Estas alteraciones de la sustancia blanca sufren cambios morfológicos a lo largo de los primeros años de vida, dejando atrofia cerebral. Las secuelas neurológicas que dejan estas alteraciones son severas y crónicas.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Pascual-Castroviejo I, et al. Citomegalia congénita y malformaciones corticales y subcorticales. Neurología. 2012;27:336–42.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1269 "Ancho" => 950 "Tamanyo" => 138723 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Case 1: Neonate with intrauterine cytomegalovirus. Axial CT slice showing sizeable bilateral open-lipped schizencephaly and a large central defect with an absent corpus callosum and septum pellucidum.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3006 "Ancho" => 1643 "Tamanyo" => 316736 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Case 4: Patient aged 5 months with intrauterine cytomegalovirus. MR study. (A) the T2-weighted axial slice shows pachygyria- and polymicrogyria-type cortical malformations, dilation of lateral ventricles, and diffuse hyperintense image in the white matter in both hemispheres. (B) T1-weighted coronal section of the same study, showing few gyri, the considerable width of the cortical grey matter (polymicrogyria) and substantial passive dilation and roundness of lateral ventricles.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3433 "Ancho" => 1641 "Tamanyo" => 436313 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Case 5: Patient aged 6 months. (A) MR axial section at level of the base of the brain showing a wide hyperintense zone in the white matter on both hemispheres. (B) T2-weighted coronal section of the same study. Note the cortical abnormalities and diffuse hyperintensity in the white matter, predominantly in the posterior and anterior areas of the brain.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 3379 "Ancho" => 1646 "Tamanyo" => 435360 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Same patient as in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> at the age of one year. (A) The axial slice shows the same cortical and subcortical alterations that were visible at 6 months, but hyperintensity of the white matter lesions has decreased. (B) The coronal slice also shows alterations in the white matter similar to those seen at 6 months.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1267 "Ancho" => 950 "Tamanyo" => 160390 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Same patient as in <a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a> at age two and a half. The axial section of the T1-weighted MR image shows cortical alterations similar to those observed in the patient at 6 months and 1 year; the hyperintense zones are more concentrated within a number of areas, especially in posterior areas.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">AET, antiepileptic treatment; alt., alterations; botu toxin, spasticity treated with botulinum toxin; BOLS, bilateral open-lipped schizencephaly; cc., corpus callosum; F, female; gen., generalised; hypoact., hypoactivity; IU, intrauterine; lissen.-polymicro., lissencephaly-polymicrogyria; hip lux., hip luxation; m, months; M, male; microc.: microcephaly; NN, neonate; physio., physiotherapy; PMD, psychomotor delay; RCL, right-sided closed lip schizencephaly; schizen., schizencephaly; SP, septum pellucidum; spast., spastic; stim., stimulation; WM, white matter.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Reason for consultation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Pregnancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Childbirth \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">EEG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Malformation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Progress \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cytomegaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cytomegaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microc.; seizures; PMD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bilateral alt. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Schizen. BOLS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stim.; physio; AET \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lost to follow-up in 1st year \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Schizen. IU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cytomegalovirus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microc. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gen. hypoactivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Schizen. BOLS; absence of SP and cc. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stim.; physio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lost to follow-up in 1st year \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NN \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Schizen. IU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cytomegalovirus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microc. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Schizen. RCL; lack of SP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stim.; physio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lost to follow-up in 1st year \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microc. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microc.; PMD; seizures; spasticity; deafness; cytomegaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Focal and gen. alt. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lissen.-polimicro; changes in WM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AET; physio.; stim.; botu. toxin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">At 8 years of age: microc; RP-M; spastic gait \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3<span class="elsevierStyleHsp" style=""></span>mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microc. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microc.; RP-M; seizures; spastic; cytomega \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Focal alt. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lissen.-polymicro.: changes in SB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AET; physio.; stim.; botu. toxin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">At 10 years: microc.; PMD; spast. gait \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2<span class="elsevierStyleHsp" style=""></span>mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microc. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microc.; RP-M; seizures; spasticity; cytomegaly \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gen. alt. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lissen.-polymicro.; WM changes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">At 12 years of age: microc; PMD; spastic gait \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab264928.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Intrauterine cytomegalovirus sequelae.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malformaciones del desarrollo cortical y su repercusión clínica en una serie de 144 casos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Pascual-Castroviejo" 1 => "S.I. Pascual-Pascual" 2 => "J. Viaño" 3 => "V. Martínez" 4 => "R. Palencia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2003" "volumen" => "37" "paginaInicial" => "327" "paginaFinal" => "344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14533110" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Structural organization of the human cerebral cortex prior to the appearance of the cortical plate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Marin-Padilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anat Embryol" "fecha" => "1983" "volumen" => "168" "paginaInicial" => "21" "paginaFinal" => "40" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6650855" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disorders of neuronal migration" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.G. Barth" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Neurol Sci" "fecha" => "1987" "volumen" => "14" "paginaInicial" => "1" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3545413" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuronal migration defects of the cerebral cortex: a destination debacle" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.F. Uher" 1 => "J.A. Golden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Genet" "fecha" => "2000" "volumen" => "58" "paginaInicial" => "16" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10945656" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Propuesta para una clasificación genética molecular de las malformaciones del sistema nervioso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.B. Sarnat" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2001" "volumen" => "33" "paginaInicial" => "68" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11562863" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consequences of reduced cerebral blood flow in brain development. I. Gross morphology, histology, and callosal connectivity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Miller" 1 => "D. Nagy" 2 => "B.L. Finlay" 3 => "B. Chance" 4 => "A. Kobayashi" 5 => "S. Nioka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1006/exnr.1993.1203" "Revista" => array:6 [ "tituloSerie" => "Exp Neurol" "fecha" => "1993" "volumen" => "124" "paginaInicial" => "326" "paginaFinal" => "342" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7507062" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Developmental neuropathology and impact of perinatal brain damage. III. Gray matter lesions of the neocortex" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Marin-Padilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Neuropathol Exp Neurol" "fecha" => "1999" "volumen" => "58" "paginaInicial" => "407" "paginaFinal" => "429" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10331430" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Shaken infant syndrome: developmental neuropathology, progressive cortical dysplasia, and epilepsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Marin-Padilla" 1 => "J.E. Parisi" 2 => "D.L. Armstrong" 3 => "S.K. Sargent" 4 => "J.A. Kaplan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Neuropathol (Berl)" "fecha" => "2002" "volumen" => "103" "paginaInicial" => "321" "paginaFinal" => "332" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malformations of cortical development: burdens and insights from important causes of human epilepsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.M. Sisodiya" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet Neurol" "fecha" => "2004" "volumen" => "3" "paginaInicial" => "29" "paginaFinal" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14693109" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Altered corticogenesis and neuronal morphology in irradiation-induced cortical dysplasia: a Golgi-Cox study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Marin-Padilla" 1 => "R.J. Tsai" 2 => "M.A. King" 3 => "S.N. Roper" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Neuropathol Exp Neurol" "fecha" => "2003" "volumen" => "62" "paginaInicial" => "1129" "paginaFinal" => "1143" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14656071" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital and perinatal cytomegalovirus infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.A. Alford" 1 => "S. Stagno" 2 => "R.F. Pass" 3 => "W.J. Britt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Rev Infect Dis" "fecha" => "1990" "volumen" => "12" "numero" => "Suppl. 7" "paginaInicial" => "S745" "paginaFinal" => "S753" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2173104" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention of maternal cytomegalovirus: current status and future aspects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. Nyholm" 1 => "M.R. Schleiss" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Women Health" "fecha" => "2010" "volumen" => "2" "paginaInicial" => "23" "paginaFinal" => "35" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital and perinatal infections: throwing new light with an old TORCH" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Shet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12098-010-0254-3" "Revista" => array:6 [ "tituloSerie" => "Indian J Pediatr" "fecha" => "2011" "volumen" => "78" "paginaInicial" => "88" "paginaFinal" => "95" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20953849" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic markers of symptomatic conventional human cytomegalovirus infection in fetal flood" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Fabbri" 1 => "M.G. Revello" 2 => "M. Furione" 3 => "M. Zabattoni" 4 => "D. Lilleri" 5 => "B. Tassis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1471-0528.2010.02822.x" "Revista" => array:6 [ "tituloSerie" => "BJOG" "fecha" => "2011" "volumen" => "118" "paginaInicial" => "448" "paginaFinal" => "456" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21199291" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptomatic infant characteristics of congenital cytomegalovirus disease in Australia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.C. Munro" 1 => "D. Trincado" 2 => "B. Hall" 3 => "W.D. Rawlinson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr Child Health" "fecha" => "2005" "volumen" => "41" "paginaInicial" => "449" "paginaFinal" => "452" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Viral infections of the fetus and newborn infant" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Tremolada" 1 => "S. Delbue" 2 => "P. Ferrante" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Med Chir" "fecha" => "2008" "volumen" => "30" "paginaInicial" => "177" "paginaFinal" => "191" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19216201" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital cytomegaly-advances in diagnosis and therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Milewska-Bobula" 1 => "B. Lipka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Przegl Epidemiol" "fecha" => "2009" "volumen" => "63" "paginaInicial" => "79" "paginaFinal" => "83" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19522232" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital cytomegalovirus disease: a NOW problem" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.D. Yow" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Infect Dis" "fecha" => "1989" "volumen" => "159" "paginaInicial" => "163" "paginaFinal" => "167" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2536778" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epilepsy and disorders of cortical development in children with congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Perez-Jimenez" 1 => "V. Colamaria" 2 => "A. Franco" 3 => "R. Grimau-Merino" 4 => "F. Darra" 5 => "E. Fontana" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "1998" "volumen" => "26" "paginaInicial" => "42" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9533204" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Depression of cellular immunity in pregnancy due to a serum factor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.A. St Hill" 1 => "R. Finn" 2 => "V. Denye" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br Med J" "fecha" => "1973" "volumen" => "III" "paginaInicial" => "513" "paginaFinal" => "514" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines on CMV congenital infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Coll" 1 => "G. Benoist" 2 => "Y. Ville" 3 => "L.E. Weisman" 4 => "F. Botet" 5 => "M.M. Anceschi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Perinatal Med" "fecha" => "2009" "volumen" => "37" "paginaInicial" => "433" "paginaFinal" => "445" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital cytomegalovirus infection: the impact of cerebral cortical malformations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.L. Engman" 1 => "I. Lewensohn-Fuchs" 2 => "M. Mosskin" 3 => "G. Malm" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1651-2227.2010.01852.x" "Revista" => array:6 [ "tituloSerie" => "Acta Paediatr" "fecha" => "2010" "volumen" => "99" "paginaInicial" => "1344" "paginaFinal" => "1349" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20456271" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abnormal white matter lesions with sensorineural hearing loss caused by congenital cytomegalovirus infection: retrospective diagnosis by PCR using Guthrie cards" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Haginoya" 1 => "T. Ohura" 2 => "K. Kon" 3 => "T. Yagi" 4 => "Y. Sawaishi" 5 => "K.K. Ishii" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Brain Dev" "fecha" => "2002" "volumen" => "24" "paginaInicial" => "710" "paginaFinal" => "714" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12427519" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retrospective diagnostics of congenital cytomegalovirus infection performed by polymerase chain reaction in blood stored on filter paper" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.J. Johansson" 1 => "M. Jonsson" 2 => "K. Ahlfors" 3 => "S.A. Ivarsson" 4 => "L. Svanberg" 5 => "C. Guthenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Infect Dis" "fecha" => "1997" "volumen" => "29" "paginaInicial" => "465" "paginaFinal" => "468" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9435033" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital cytomegalovirus infection: a retrospective diagnosis in a child with pachygyria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Malm" 1 => "E.H. Grondahl" 2 => "I. Lewensohn-Fuchs" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Neurol" "fecha" => "2000" "volumen" => "22" "paginaInicial" => "407" "paginaFinal" => "408" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10913736" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Perinatal infections and fetal/neonatal brain injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.J. Ledger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Curr Opin Obstrt Gynecol" "fecha" => "2008" "volumen" => "20" "paginaInicial" => "120" "paginaFinal" => "124" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fetal manifestations and pour outcomes of congenital cytomegalovirus infections: possible candidates for intrauterine antiviral treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Maruyama" 1 => "H. Sameshima" 2 => "M. Kamitomo" 3 => "S. Ibara" 4 => "M. Kaneko" 5 => "T. Ikenowe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1447-0756.2007.00621.x" "Revista" => array:6 [ "tituloSerie" => "J Obstet Gynaecol Res" "fecha" => "2007" "volumen" => "33" "paginaInicial" => "619" "paginaFinal" => "623" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17845318" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Late intrauterine cytomegalovirus infection: clinical and neuroimaging findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.I. Steinlin" 1 => "D. Nadal" 2 => "G.F. Eich" 3 => "E. Martin" 4 => "E.J. Boltshauser" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Neurol" "fecha" => "1996" "volumen" => "15" "paginaInicial" => "249" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8916166" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lisencephaly-pachygyria associated with congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.C. Hayward" 1 => "D.S. Titelbaum" 2 => "R.R. Clancy" 3 => "R.A. Zimmerman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Child Neurol" "fecha" => "1991" "volumen" => "6" "paginaInicial" => "109" "paginaFinal" => "114" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1646253" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prenatal cytomegalovirus disease and cerebral microgyria; evidence for perfusion failure, not disturbance of histogenesis, as the major cause of fetal cytomegalovirus encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.J. Marques Dias" 1 => "G. Harmant-van Rijckevorsel" 2 => "C. Landrieu" 3 => "G. Lyon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2008-1052334" "Revista" => array:6 [ "tituloSerie" => "Neuropediatrics" "fecha" => "1984" "volumen" => "15" "paginaInicial" => "18" "paginaFinal" => "24" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6324014" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital cytomegalovirus infection of the brain: imaging analysis and embryologic considerations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.J. Barkovich" 1 => "C.I. Linden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "1994" "volumen" => "15" "paginaInicial" => "703" "paginaFinal" => "715" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8010273" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000002700000006/v1_201305151336/S2173580812001186/v1_201305151336/en/main.assets" "Apartado" => array:4 [ "identificador" => "9491" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735808/0000002700000006/v1_201305151336/S2173580812001186/v1_201305151336/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580812001186?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 59 | 3 | 62 |
| 2024 September | 89 | 11 | 100 |
| 2024 August | 89 | 3 | 92 |
| 2024 July | 91 | 5 | 96 |
| 2024 June | 86 | 3 | 89 |
| 2024 May | 80 | 3 | 83 |
| 2024 April | 113 | 6 | 119 |
| 2024 March | 129 | 6 | 135 |
| 2024 February | 85 | 6 | 91 |
| 2024 January | 70 | 11 | 81 |
| 2023 December | 68 | 5 | 73 |
| 2023 November | 59 | 10 | 69 |
| 2023 October | 95 | 11 | 106 |
| 2023 September | 49 | 6 | 55 |
| 2023 August | 48 | 5 | 53 |
| 2023 July | 72 | 5 | 77 |
| 2023 June | 55 | 6 | 61 |
| 2023 May | 108 | 5 | 113 |
| 2023 April | 83 | 3 | 86 |
| 2023 March | 81 | 5 | 86 |
| 2023 February | 59 | 10 | 69 |
| 2023 January | 65 | 9 | 74 |
| 2022 December | 44 | 6 | 50 |
| 2022 November | 68 | 8 | 76 |
| 2022 October | 49 | 14 | 63 |
| 2022 September | 57 | 15 | 72 |
| 2022 August | 69 | 24 | 93 |
| 2022 July | 89 | 10 | 99 |
| 2022 June | 65 | 7 | 72 |
| 2022 May | 56 | 10 | 66 |
| 2022 April | 56 | 9 | 65 |
| 2022 March | 65 | 17 | 82 |
| 2022 February | 65 | 10 | 75 |
| 2022 January | 100 | 16 | 116 |
| 2021 December | 85 | 26 | 111 |
| 2021 November | 74 | 15 | 89 |
| 2021 October | 84 | 16 | 100 |
| 2021 September | 91 | 28 | 119 |
| 2021 August | 64 | 6 | 70 |
| 2021 July | 46 | 9 | 55 |
| 2021 June | 24 | 9 | 33 |
| 2021 May | 56 | 14 | 70 |
| 2021 April | 114 | 25 | 139 |
| 2021 March | 110 | 7 | 117 |
| 2021 February | 62 | 7 | 69 |
| 2021 January | 51 | 8 | 59 |
| 2020 December | 53 | 9 | 62 |
| 2020 November | 42 | 15 | 57 |
| 2020 October | 39 | 6 | 45 |
| 2020 September | 48 | 14 | 62 |
| 2020 August | 47 | 5 | 52 |
| 2020 July | 31 | 9 | 40 |
| 2020 June | 36 | 7 | 43 |
| 2020 May | 35 | 16 | 51 |
| 2020 April | 26 | 6 | 32 |
| 2020 March | 33 | 11 | 44 |
| 2020 February | 36 | 3 | 39 |
| 2020 January | 43 | 11 | 54 |
| 2019 December | 73 | 12 | 85 |
| 2019 November | 28 | 9 | 37 |
| 2019 October | 49 | 16 | 65 |
| 2019 September | 45 | 12 | 57 |
| 2019 August | 42 | 14 | 56 |
| 2019 July | 41 | 9 | 50 |
| 2019 June | 78 | 19 | 97 |
| 2019 May | 222 | 33 | 255 |
| 2019 April | 102 | 22 | 124 |
| 2019 March | 34 | 7 | 41 |
| 2019 February | 41 | 13 | 54 |
| 2019 January | 37 | 16 | 53 |
| 2018 December | 28 | 7 | 35 |
| 2018 November | 37 | 3 | 40 |
| 2018 October | 38 | 17 | 55 |
| 2018 September | 16 | 9 | 25 |
| 2018 August | 17 | 1 | 18 |
| 2018 July | 11 | 5 | 16 |
| 2018 June | 11 | 2 | 13 |
| 2018 May | 13 | 1 | 14 |
| 2018 April | 18 | 2 | 20 |
| 2018 March | 19 | 2 | 21 |
| 2018 February | 22 | 9 | 31 |
| 2018 January | 12 | 1 | 13 |
| 2017 December | 12 | 0 | 12 |
| 2017 November | 15 | 5 | 20 |
| 2017 October | 22 | 3 | 25 |
| 2017 September | 20 | 4 | 24 |
| 2017 August | 26 | 6 | 32 |
| 2017 July | 20 | 2 | 22 |
| 2017 June | 54 | 5 | 59 |
| 2017 May | 31 | 5 | 36 |
| 2017 April | 20 | 2 | 22 |
| 2017 March | 29 | 23 | 52 |
| 2017 February | 39 | 7 | 46 |
| 2017 January | 32 | 5 | 37 |
| 2016 December | 37 | 13 | 50 |
| 2016 November | 46 | 6 | 52 |
| 2016 October | 53 | 7 | 60 |
| 2016 September | 79 | 13 | 92 |
| 2016 August | 39 | 7 | 46 |
| 2016 July | 57 | 2 | 59 |
| 2016 June | 56 | 17 | 73 |
| 2016 May | 53 | 18 | 71 |
| 2016 April | 42 | 23 | 65 |
| 2016 March | 53 | 27 | 80 |
| 2016 February | 56 | 22 | 78 |
| 2016 January | 56 | 19 | 75 |
| 2015 December | 41 | 10 | 51 |
| 2015 November | 26 | 13 | 39 |
| 2015 October | 47 | 9 | 56 |
| 2015 September | 31 | 6 | 37 |
| 2015 August | 53 | 8 | 61 |
| 2015 July | 44 | 7 | 51 |
| 2015 June | 33 | 1 | 34 |
| 2015 May | 39 | 9 | 48 |
| 2015 April | 49 | 6 | 55 |
| 2015 March | 49 | 6 | 55 |
| 2015 February | 42 | 1 | 43 |
| 2015 January | 26 | 15 | 41 |
| 2014 December | 46 | 11 | 57 |
| 2014 November | 25 | 8 | 33 |
| 2014 October | 30 | 6 | 36 |
| 2014 September | 31 | 6 | 37 |
| 2014 August | 43 | 6 | 49 |
| 2014 July | 43 | 9 | 52 |
| 2014 June | 28 | 4 | 32 |
| 2014 May | 22 | 5 | 27 |
| 2014 April | 8 | 2 | 10 |
| 2014 March | 24 | 4 | 28 |
| 2014 February | 17 | 5 | 22 |
| 2014 January | 20 | 5 | 25 |
| 2013 December | 34 | 4 | 38 |
| 2013 November | 37 | 8 | 45 |
| 2013 October | 75 | 9 | 84 |
| 2013 September | 60 | 2 | 62 |
| 2013 August | 43 | 6 | 49 |
| 2013 July | 23 | 2 | 25 |
Show all
