Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection

array:25 ["pii" => "S2173580821001401" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2018.11.011" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "1272" "copyright" => "Sociedad Española de Neurología" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2022;37:122-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:20 [ "pii" => "S021348531930012X" "issn" => "02134853" "doi" => "10.1016/j.nrl.2018.11.003" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "1272" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2022;37:122-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 947 "formatos" => array:3 [ "EPUB" => 50 "HTML" => 392 "PDF" => 505 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Asociación entre neuroimagen y secuelas neurológicas en pacientes con infección congénita por citomegalovirus" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "122" "paginaFinal" => "129" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection" ] ] "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" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2180 "Ancho" => 1255 "Tamanyo" => 204448 ] ] "descripcion" => array:1 [ "es" => "Hallazgos de neuroimagen correspondientes a cada estadio de la escala de Noyola et al. modificada: a y b) Corte axial T1 de la RM cerebral y ecografía transfontanelar del paciente de 43 días de vida, clasificado como grado 1 en la escala de Noyola modificada: se objetiva la presencia de un quiste germinolítico de 6mm en el surco talamocaudado izquierdo, así como ventriculomegalia leve del ventrículo lateral izquierdo; c y d) RM cerebral, corte axial T2. Paciente de 2 meses de vida, clasificado como grado 2. Encefalopatía multiquística; e) RM cerebral, corte axial T1. Paciente de 4 meses de vida, clasificado como grado 3 en la escala de Noyola modificada. Extensa pérdida de la diferenciación corticosubcortical de la sustancia gris cortical perisilviana. Hipoplasia del cuerpo calloso. Anomalías de la migración neuronal y/o heterotopia en banda. Aumento de señal de la sustancia blanca subcortical de ambos polos temporales por gliosis o malacia. Ventrículos en el límite alto de la normalidad, y f) RM cerebral, corte axial secuencia FLAIR. Paciente de 6 meses, clasificado como grado de 3 en la escala de Noyola modificada. Alteración parcheada de la señal de la sustancia blanca de ambos hemisferios y asimetría hemisférica con menor tamaño de hemisferio derecho y ventriculomegalia asociada. Pérdida de la diferenciación córtico-subcortical y aumento de la sulcación compatible con polimicrogiria." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Escobar Castellanos, S. de la Mata Navazo, M. Carrón Bermejo, M. García Morín, Y. Ruiz Martín, J. Saavedra Lozano, M.C. Miranda Herrero, E. Barredo Valderrama, P. Castro de Castro, M. Vázquez López" "autores" => array:10 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Escobar Castellanos" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "de la Mata Navazo" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Carrón Bermejo" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "García Morín" ] 4 => array:2 [ "nombre" => "Y." "apellidos" => "Ruiz Martín" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Saavedra Lozano" ] 6 => array:2 [ "nombre" => "M.C." "apellidos" => "Miranda Herrero" ] 7 => array:2 [ "nombre" => "E." "apellidos" => "Barredo Valderrama" ] 8 => array:2 [ "nombre" => "P." "apellidos" => "Castro de Castro" ] 9 => array:2 [ "nombre" => "M." "apellidos" => "Vázquez López" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173580821001401" "doi" => "10.1016/j.nrleng.2018.11.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821001401?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021348531930012X?idApp=UINPBA00004N" "url" => "/02134853/0000003700000002/v2_202203180842/S021348531930012X/v2_202203180842/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2173580820300705" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2018.04.002" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "1222" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "Neurologia. 2022;37:130-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Review article" "titulo" => "Controversies in cerebrovascular disease: high or low doses of recombinant tissue plasminogen activator to treat acute stroke? A literature review" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "130" "paginaFinal" => "135" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Controversias en enfermedad cerebrovascular: rt-PA a dosis bajas vs. dosis estándar en el tratamiento del ictus agudo. Una revisión de la literatura" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Montalván Ayala, Z. Rojas Cheje, R. Aldave Salazar" "autores" => array:3 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Montalván Ayala" ] 1 => array:2 [ "nombre" => "Z." "apellidos" => "Rojas Cheje" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Aldave Salazar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485318301452" "doi" => "10.1016/j.nrl.2018.04.003" "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/S0213485318301452?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580820300705?idApp=UINPBA00004N" "url" => "/21735808/0000003700000002/v1_202203100608/S2173580820300705/v1_202203100608/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2173580821000109" "issn" => "21735808" "doi" => "10.1016/j.nrleng.2018.10.022" "estado" => "S300" "fechaPublicacion" => "2022-03-01" "aid" => "1273" "copyright" => "Sociedad Española de Neurología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Neurologia. 2022;37:110-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Peripheral blood lymphocyte phenotypes in Alzheimer and Parkinson’s diseases" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "110" "paginaFinal" => "121" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fenotipos de linfocitos periféricos en las enfermedades de Alzheimer y Parkinson" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1906 "Ancho" => 1500 "Tamanyo" => 121452 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Proportion of memory T cells in patients with Alzheimer disease (A) and patients with Parkinson’s disease (B), compared to healthy controls (HC). * P-value between .01 and .05. ** P-value between .0001 and .01. *** P-value < .0001." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Garfias, B. Tamaya Domínguez, A. Toledo Rojas, M. Arroyo, U. Rodríguez, C. Boll, A.L. Sosa, E. Sciutto, L. Adalid-Peralta, Y. Martinez López, G. Fragoso, A. Fleury" "autores" => array:12 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Garfias" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Tamaya Domínguez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Toledo Rojas" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Arroyo" ] 4 => array:2 [ "nombre" => "U." "apellidos" => "Rodríguez" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Boll" ] 6 => array:2 [ "nombre" => "A.L." "apellidos" => "Sosa" ] 7 => array:2 [ "nombre" => "E." "apellidos" => "Sciutto" ] 8 => array:2 [ "nombre" => "L." "apellidos" => "Adalid-Peralta" ] 9 => array:2 [ "nombre" => "Y." "apellidos" => "Martinez López" ] 10 => array:2 [ "nombre" => "G." "apellidos" => "Fragoso" ] 11 => array:2 [ "nombre" => "A." "apellidos" => "Fleury" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213485319300131" "doi" => "10.1016/j.nrl.2018.10.004" "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/S0213485319300131?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821000109?idApp=UINPBA00004N" "url" => "/21735808/0000003700000002/v1_202203100608/S2173580821000109/v1_202203100608/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "122" "paginaFinal" => "129" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Escobar Castellanos, S. de la Mata Navazo, M. Carrón Bermejo, M. García Morín, Y. Ruiz Martín, J. Saavedra Lozano, M.C. Miranda Herrero, E. Barredo Valderrama, P. Castro de Castro, M. Vázquez López" "autores" => array:10 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Escobar Castellanos" "email" => array:1 [ 0 => "mariaescobarcastellanos121091@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "de la Mata Navazo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Carrón Bermejo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "García Morín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Y." "apellidos" => "Ruiz Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "J." "apellidos" => "Saavedra Lozano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "M.C." "apellidos" => "Miranda Herrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "E." "apellidos" => "Barredo Valderrama" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "P." "apellidos" => "Castro de Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "M." "apellidos" => "Vázquez López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Radiología, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección de Infectología, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Asociación entre neuroimagen y secuelas neurológicas en pacientes con infección congénita por citomegalovirus" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3776 "Ancho" => 2174 "Tamanyo" => 712188 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Neuroimaging findings corresponding to the stages of the modified Noyola classification; (a and b) axial slices from T1-weighted brain MRI and transfontanellar ultrasound studies of a 43-day-old patient, scoring 1 on the classification. It shows the presence of a 6-mm germinolytic cyst in the left caudothalamic groove, as well as mild ventriculomegaly of the left lateral ventricle; (c and d) axial slices from T2-weighted brain MRI of a 2-month-old patient, with lesions scoring 2. Multicystic encephalopathy; (e) axial slice from a T1-weighted brain MRI scan of a 4-month-old patient, with a lesion scoring 3. Extensive loss of cortico-subcortical differentiation of the cortical perisylvian grey matter. Hypoplasia of the corpus callosum. Anomalies of neuronal migration and/or band heterotopia. Increased signal in the subcortical white matter of both temporal poles due to gliosis or malacia. Ventricles in the higher threshold of normality; (f) axial slice from a brain MRI FLAIR sequence of a 6-month-old patient, with a lesion scoring 3. Patchy signal in the white matter of both hemispheres and hemispheric asymmetry, with the right hemisphere being smaller in size and showing associated ventriculomegaly. Loss of cortico-subcortical differentiation and increased sulcation, compatible with polymicrogyria." ] ] ] "textoCompleto" => "IntroductionCongenital cytomegalovirus (CMV) infection is one of the most frequent prenatal infections in developed countries, affecting between 0.3% and 0.6% of newborns in Europe.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> It is the most frequent cause of delayed psychomotor development and hearing loss of infectious origin.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Only 10% of newborns with the infection will present symptoms at birth (intrauterine growth retardation, hepatosplenomegaly, thrombocytopaenia, jaundice, petechiae, microcephalus, or abnormal neurological examination findings)<a class="elsevierStyleCrossRef" href="#bib0015">3</a>; 90% of neonates are asymptomatic, although 13% of these patients will present sequelae throughout their lives.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>The central nervous system (CNS) is affected in 50% of children with symptomatic infection,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> leading to alterations in psychomotor development, sensorineural hearing loss, and chorioretinitis.<a class="elsevierStyleCrossRefs" href="#bib0015">3–7</a>Neuroimaging studies of these patients only detect alterations in two-thirds of cases; the most frequent alterations are presence of cerebral calcifications, ventriculomegaly, periventricular white matter alterations, neuronal migration disorders, cortical atrophy, periventricular cysts, and cerebellar hypoplasia.<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a>Most studies on brain involvement in congenital CMV infection are based on computed tomography (CT) findings; however, this technique causes ionising radiation and is not superior to ultrasound for detecting ventriculomegaly, subependymal cysts, calcifications, or lenticulostriate vasculopathy (LSV).<a class="elsevierStyleCrossRefs" href="#bib0010">2,7,10–13</a>Recent studies have aimed to establish the prognostic role of transfontanellar ultrasound and magnetic resonance imaging (MRI) in cerebral involvement of congenital CMV infection.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> However, further studies are needed to determine the precise prognostic role of brain MRI, especially in patients with white matter lesions.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>The aim of this study is to analyse the relationship between imaging alterations (prenatal ultrasound, transfontanellar ultrasound and MRI) and neurological involvement in patients with congenital CMV infection.Patients and methodsWe conducted an observational, retrospective, analytical study in the paediatric neurology department in collaboration with the paediatric radiology and the paediatric infectious diseases department at a tertiary hospital in the Region of Madrid (Spain).The study period was from January 2003 to August 2017.We included patients under follow-up by the paediatric neurology department and diagnosed with congenital CMV infection. This department follows up all patients with confirmed infection, whether symptomatic or asymptomatic. Congenital CMV infection was confirmed by positive PCR or urine culture findings for CMV in the first 15 days of life or positive PCR for CMV in dried blood spots (Guthrie card) from the first 48 hours of life.Infection was considered symptomatic at birth when patients presented: intrauterine growth retardation (defined as weight at birth more than 2 standard deviations [SD] below the mean), petechiae, hepatomegaly, splenomegaly, microcephalus (defined as head circumference at birth more than 2 SD below the mean), sensorineural hearing loss (altered otoacoustic emissions, confirmed by auditory evoked potentials), chorioretinitis, thrombocytopaenia (less than 100 000 platelets/μL), elevated liver enzymes (alanine transferase > 100 U/L [normal range: 5-50 U/L]), or cholestasis (direct bilirubin > 3 mg/dL [normal range: 0-0.3 mg/dL]).Neuroimaging studies and scorePathological brain ultrasound findings were defined as intracranial calcifications, ventriculomegaly (axial diameter greater than 10 mm across the atrium at the level of the posterior horns), germinolytic cysts, and/or lenticulostriate vasculopathy. The ultrasound devices used were the Toshiba Xario and Aplio systems.In the brain MRI study, we obtained sagittal, axial, and coronal slices in T1- and T2-weighted sequences with a 1.5 T scanner. A paediatric radiologist interpreted the images. A second paediatric radiologist reviewed the images, assigning a severity score according to the modified version<a class="elsevierStyleCrossRef" href="#bib0070">14</a> of the Noyola scoring scale,<a class="elsevierStyleCrossRef" href="#bib0045">9</a> as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Neurodevelopmental evaluationNeurological involvement was assessed in the last consultation and was considered to include the following items: microcephalus (head circumference at birth more than 2 SD below the mean according to the tables published by Fernández et al.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>), psychomotor retardation according to the Denver scale (as assessed by an experienced paediatric neurologist), motor alterations (classified as mild, moderate, or severe), behavioural alterations, cognitive alterations, speech impairment, and seizures. Presence of hearing alterations (losses greater than 20 dB) and chorioretinitis was also assessed.Statistical analysisQualitative variables are expressed as numbers and percentages. Continuous variables are expressed as mean ± SD for normally distributed data and median ± interquartile range for non–normally distributed data. We used the chi-square test or the Fisher exact test to compare qualitative variables and the t test or Mann–Whitney U test to compare continuous variables. Statistical analysis was conducted using SPSS®. P values < .05 were considered significant.ResultsOf a total of 36 patients, 17 (47.2%) were boys. Six patients (16.7%) were born preterm and 10 (27%) presented low birth weight. Mean birth weight was 2775.6 g ± 622.8 and mean head circumference at birth was 33.1 cm ± 2.0. Eight patients (22%) presented microcephalus at birth.Congenital CMV infection was suspected before birth in 24 patients (66.7%). We observed alterations in prenatal ultrasound studies of 13 patients (36%); the main findings were intrauterine growth retardation and ventriculomegaly observed during the third trimester.Twenty patients (55.6%) presented symptoms compatible with congenital CMV infection at birth; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> lists the most frequent clinical manifestations.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Antiviral treatment (oral valganciclovir) was administered to 20 patients (55.6%). Sixteen of the 24 patients in whom CMV infection was suspected before birth (66.7%) started treatment before one month of life.The most recent follow-up consultation in the paediatric neurology clinic was performed when patients had a mean age of 49.6 ± 40.0 months (4 years). Eighteen patients (50%) were asymptomatic and the remaining 18 presented neurological sequelae: 15 patients (41.7%) showed psychomotor retardation, which was severe in only 2 cases. Eleven patients (30%) presented cognitive alterations and 12 (33%) presented speech impairment. Only 2 patients (5.6%) presented seizures. Twelve patients (33.3%) had hearing alterations, with 3 (25%) requiring cochlear implants. Two patients (5.6%) presented visual disturbances due to chorioretinitis. None of the 36 patients died during the study period.Fifteen of the patients with neurological alterations in the last follow-up consultation (83.3%) presented symptoms at birth (P = .001). Ten (55.6%) presented alterations in the transfontanellar ultrasound performed in the first months of life (P = .013) and 16 (88.9%) presented abnormal brain MRI findings (P < .001).Neuroimaging techniquesAll patients underwent at least one imaging study (transfontanellar ultrasound, brain MRI, or both).The main neuroimaging findings are detailed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Prenatal ultrasound and MRIThirteen patients presented anomalies compatible with congenital CMV infection in the prenatal ultrasound. Of these patients, 11 (84.6%) presented symptoms at birth (P = .008). Ten (79.6%) subsequently presented alterations in the brain MRI study (P = .07). Twelve patients with alterations compatible with congenital CMV infection in the prenatal ultrasound (92.3%) presented neurological alterations in the most recent neurology follow-up consultation (P < .001).Four patients underwent a prenatal MRI study, with 3 showing alterations (ventriculomegaly, cortical atrophy, and/or white matter alterations).Transfontanellar ultrasoundTransfontanellar ultrasound studies were performed in 30 patients (83.3%), and alterations were detected in 20 (66%).Eleven patients (55%) in the latter group had presented symptoms compatible with congenital CMV infection at birth (P = .024). Also, 11 (55%) of these patients presented brain MRI anomalies (P = .044), which were severe in 50%. Eight of the 10 patients with normal transfontanellar ultrasound findings presented normal psychomotor development (P = .003). Ten of the 20 patients showing alterations in the transfontanellar ultrasound presented delayed psychomotor development (P = .001).LSV was observed in 8 of the 30 transfontanellar ultrasounds. No association was identified between presence of LSV and symptoms at birth (P = .108); of the 8 patients with LSV, 5 (62.5%) presented delayed psychomotor development (P = .045).As a predictor of neurological sequelae, transfontanellar ultrasound presented a sensitivity of 83.3%, (90% CI, 58-100), specificity of 44.4% (90% CI, 18.7-70.2), positive predictive value of 50% (90% CI, 25.6-74.4), and a negative predictive value of 80% (90% CI, 50.2-100).Brain MRIBrain MRI studies were performed in 29 patients (80%), at a mean age of 19.25 months (0.23-111.41). MRI detected alterations in 19 patients (70%); the most frequent alterations are detailed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>A positive correlation was identified between brain MRI alterations, presence of symptoms at birth, and the presence of neurological alterations. Thirteen patients with brain MRI alterations compatible with congenital CMV infection (68.4%) had presented symptoms at birth (P = .25). Sixteen patients with brain MRI alterations (84.2%) presented neurological alterations in the last follow-up consultation at the paediatric neurology clinic (P < .001); <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> lists the main neurological deficits detected.According to the modified Noyola classification, 14 patients (38.9%) presented alterations scoring 0, 6 patients (16.6%) had alterations scoring 1, 12 patients (33.3%) had alterations scoring 2, and 4 patients (11.1%) had alterations scoring 3; a positive correlation was observed between presence of severe alterations in neuroimaging studies and neurological involvement: all 4 of the patients with alterations scoring 3 presented delayed psychomotor development (P = .002) and cognitive alterations (P = .001).MRI alterations scoring 2 or 3 were observed in 12 of the 18 patients (66%) with delayed psychomotor development (P < .001), in all 6 patients with behavioural alterations (P = .003), 10 of the 11 patients (90%) with cognitive alterations (P < .001), 10 of the 12 patients (83%) with speech impairment (P = .001), and 10 of the 12 patients (83%) with hearing loss (P = .001).MRI showed a sensitivity of 94% (95% CI, 80-100), specificity of 66.6% (95% CI, 36-97.5), a positive predictive value of 80% (95% CI, 60-100), and a negative predictive value of 88% (95% CI, 68-100).DiscussionInfection with CMV during the prenatal period may cause a wide variety of neurodevelopmental alterations, which differ according to the trimester in which the infection occurred. Infection early in gestation may give rise to significant CNS malformations including lissencephaly, polymicrogyria, schizencephaly, calcifications, cerebellar hypoplasia, and/or hypoplasia/agenesis of the corpus callosum. Infection during the last months of gestation provokes less prominent alterations, such as white matter alterations or myelination disorders.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a>Although head CT studies are useful for detecting some alterations associated with neurodevelopmental retardation in these patients,<a class="elsevierStyleCrossRefs" href="#bib0040">8,16,18</a> they do not constitute the best tool for detecting neuronal migration disorders or white matter alterations; patients are also exposed to high levels of ionising radiation.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Head CT scans were not performed in any of the patients of our study; ours is the first study in which all patients diagnosed with congenital CMV infection were studied with transfontanellar ultrasound, MRI, or both.In the neonatal period, MRI and ultrasound are the techniques of choice for detecting such brain alterations as periventricular cysts, cerebellar hypoplasia, and hippocampal dysplasia.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> There is growing interest in the prognostic role of MRI for congenital CMV infection.<a class="elsevierStyleCrossRefs" href="#bib0015">3,11,14,19</a>,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Establishing a precise, early diagnosis of the risk of neurodevelopmental alterations helps us to correctly advise parents and to personalise the follow-up and treatment of each patient.<a class="elsevierStyleCrossRef" href="#bib0055">11</a>Transfontanellar ultrasound is a very useful tool for assessing the typical findings of brain involvement in congenital CMV infection, such as ventriculomegaly, periventricular cysts, and cerebral calcifications.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Furthermore, it does not expose patients to radiation or require sedation.<a class="elsevierStyleCrossRefs" href="#bib0010">2,10,20</a> The study by Alarcón et al.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> confirms that transfontanellar ultrasound is comparable to CT in terms of its capacity to detect most of the cerebral lesions caused by CMV, and shows that the Noyola classification, originally designed for CT scans, is also applicable to transfontanellar ultrasound findings. As in our study, the presence of alterations scoring 2-3 presented a high predictive value for association with alterations in psychomotor development.The role of transfontanellar ultrasound findings, and especially the presence of LSV, has been widely studied.<a class="elsevierStyleCrossRefs" href="#bib0105">21–23</a> In our study, transfontanellar ultrasound was performed in 83.3% of patients; we observed that most patients with normal findings presented adequate neurodevelopment, whereas neurodevelopmental alterations were observed in approximately half of patients presenting alterations in the transfontanellar ultrasound. These findings contrast with those obtained by Capretti et al.,<a class="elsevierStyleCrossRef" href="#bib0010">2</a> who identified a correlation between neuroimaging and neurological assessment findings in 40 patients with congenital CMV infection, with transfontanellar ultrasound showing a sensitivity of 57%. However, this may be explained by the fact that such findings as mild ventriculomegaly or LSV were not considered pathological.Furthermore, the role of LSV as an ultrasound finding in congenital CMV infection is debated. In the study by Giannattasio et al.,<a class="elsevierStyleCrossRef" href="#bib0100">20</a> LSV was not associated with poor prognosis, with neurodevelopmental alterations reported in 39% of patients with LSV and 54% of those who did not present this alteration.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> These data are consistent with the results of our study.The prospective study by Alarcón et al.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> included 26 patients with congenital CMV, and concluded that normal transfontanellar ultrasound findings are sufficient to predict favourable neurological development. However, our study included 2 patients with normal transfontanellar ultrasound findings and neurodevelopmental alterations; therefore, brain MRI was necessary to rule out brain involvement in patients diagnosed with congenital CMV infection.Some studies have shown that MRI provides additional information in 20% of cases, especially in the diagnosis of brain developmental disorders<a class="elsevierStyleCrossRef" href="#bib0070">14</a> such as temporal lobe lesions, cortical malformations, and white matter alterations.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> However, few studies have demonstrated the association between neurological prognosis and transfontanellar ultrasound and MRI alterations in patients with congenital CMV infection.White matter alterations are frequently the only manifestation of CMV infection, and may be related to psychomotor development alterations.<a class="elsevierStyleCrossRefs" href="#bib0045">9,24,25</a> In our study, 75% of patients underwent MRI studies, with white matter alterations being the most frequent alteration detected, followed by periventricular cysts. Of these patients, 84.2% presented neurological alterations in the last follow-up consultation at the paediatric neurology clinic.The study by Kwak et al.<a class="elsevierStyleCrossRef" href="#bib0130">26</a> found that the volume of white matter affected in the brain MRI scan performed at 2 years was associated with intelligence quotient scores. However, white matter lesions are sometimes difficult to distinguish from delayed myelination.<a class="elsevierStyleCrossRefs" href="#bib0050">10,27</a>Periventricular cysts are suggestive of viral infection due to the vulnerability of the germinal matrix to infection: in our study, 25% of patients undergoing MRI presented germinolytic cysts.Our results are similar to those reported by Alarcón et al.,<a class="elsevierStyleCrossRef" href="#bib0070">14</a> showing a positive correlation between the severity of neuroimaging alterations and neurological involvement. Furthermore, the presence of alterations scoring 2-3 on the Noyola classification presented a high predictive value for the association with alterations in psychomotor development.Establishing a precise, early diagnosis of the risk of neurodevelopmental alterations helps us to correctly advise parents and to personalise the follow-up and treatment of each patient.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>The strength of our study lies in the inclusion of both symptomatic and asymptomatic patients, with imaging studies performed in all cases. Furthermore, patients were followed up for a long period of time (the oldest patient was 14.3 years old). The main limitations were the exclusion of patients with congenital CMV infection who were not followed up at the paediatric neurology clinic, which may have led to bias, with the series including patients with more severe neurological involvement. Furthermore, as brain MRI was not performed at a specific age, some lesions may have been misinterpreted as immature myelination. Lesion progression could not be observed as serial MRI studies were not conducted.ConclusionsBased on our findings, we can establish a series of recommendations for the follow-up of these patients. It would be recommendable to perform transfontanellar ultrasound studies at birth and to complement the study with brain MRI and start treatment if alterations are detected. If transfontanellar ultrasound findings are normal, an MRI scan should be performed at 4 weeks, with a further brain MRI scan at 2 years to be considered in all patients with congenital CMV infection. Follow-up should continue during the school stage.FundingThis study received no public or private funding.Conflicts of interestThe authors have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1677652" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aim" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Patients and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1488035" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1677651" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Pacientes y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1488034" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Neuroimaging studies and score" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Neurodevelopmental evaluation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Neuroimaging techniques" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Prenatal ultrasound and MRI" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Transfontanellar ultrasound" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Brain MRI" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-07-19" "fechaAceptado" => "2018-11-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1488035" "palabras" => array:12 [ 0 => "Calcification" 1 => "Cytomegalovirus" 2 => "Congenital" 3 => "Ultrasound" 4 => "Neuroimaging" 5 => "Paediatrics" 6 => "Prognosis" 7 => "Magnetic resonance imaging" 8 => "Psychomotor retardation" 9 => "Sensorineural deafness" 10 => "Ventriculomegaly" 11 => "Periventricular cysts" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1488034" "palabras" => array:12 [ 0 => "Calcificaciones" 1 => "Citomegalovirus" 2 => "Congénito" 3 => "Ecografía" 4 => "Neuroimagen" 5 => "Pediatría" 6 => "Pronóstico" 7 => "Resonancia magnética" 8 => "Retraso psicomotor" 9 => "Sordera neurosensorial" 10 => "Ventriculomegalia" 11 => "Quistes periventriculares" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundCongenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. AimThe study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. Patients and methodsWe performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola’ scale. Imaging findings were compared with neurological alterations in the patients’ most recent follow-up evaluation at the paediatric neurology department. ResultsThirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P = .04) and 10 had neurological impairment (P = .008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P < .001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola’ scale values > 2 were correlated with psychomotor retardation (P < .001). ConclusionsOur findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Aim" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Patients and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa infección congénita por citomegalovirus (CMV) supone una importante causa de discapacidad. Existen escasas evidencias acerca del valor pronóstico de las lesiones presentes en los estudios de neuroimagen. ObjetivoAnalizar la gravedad de las lesiones en la resonancia magnética (RM) y la ecografía transfontanelar y su relación con déficits neurológicos a largo plazo. Pacientes y métodosSe realizó un estudio observacional analítico retrospectivo de 36 pacientes con infección congénita por CMV. Se revisaron los estudios de neuroimagen y se clasificaron según la escala de Noyola et al. modificada. Se relacionaron los hallazgos de neuroimagen con la afectación neurológica en su última visita en la consulta de neuropediatría. ResultadosUn total de 36 pacientes fueron estudiados, habiéndose realizado ecografía transfontanelar en 30 y RM cerebral en 29. La ecografía transfontanelar estuvo alterada en 20/30 pacientes, de los cuales, 11 tuvieron alteración en la RM (p = 0,04) y 10 afectación neurológica (p = 0,008). Tuvo una sensibilidad del 83,3%, IC 90%: 58–100 y una especificidad del 44,4%, IC 90%: 18,7–70,2 para la predicción de secuelas neurológicas. La RM estuvo alterada en 20/29 pacientes. Dieciséis de ellos tuvieron afectación neurológica (p < 0,001), teniendo una sensibilidad del 94%, IC 95%: 80–100 y una especificidad del 66,6%, IC 95%: 36–97,5 para la predicción de secuelas neurológicas. Una escala de Noyola et al. ≥ 2 se asoció a retraso psicomotor (p < 0,001) ConclusiónNuestro trabajo valida los estudios previos en los que se encuentra correlación estadísticamente significativa entre la extensión de las lesiones en neuroimagen y la gravedad de los déficits neurológicos." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Pacientes y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Escobar Castellanos M, de la Mata Navazo S, Carrón Bermejo M, García Morín M, Ruiz Martín Y, Saavedra Lozano J, et al. Asociación entre neuroimagen y secuelas neurológicas en pacientes con infección congénita por citomegalovirus. Neurología. 2022;37:122–129." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "This study was presented as an oral communication at the 41st Annual Meeting of the Spanish Society of Paediatric Neurology (SENEP) in Girona, 14–16 June 2018." ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3776 "Ancho" => 2174 "Tamanyo" => 712188 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Neuroimaging findings corresponding to the stages of the modified Noyola classification; (a and b) axial slices from T1-weighted brain MRI and transfontanellar ultrasound studies of a 43-day-old patient, scoring 1 on the classification. It shows the presence of a 6-mm germinolytic cyst in the left caudothalamic groove, as well as mild ventriculomegaly of the left lateral ventricle; (c and d) axial slices from T2-weighted brain MRI of a 2-month-old patient, with lesions scoring 2. Multicystic encephalopathy; (e) axial slice from a T1-weighted brain MRI scan of a 4-month-old patient, with a lesion scoring 3. Extensive loss of cortico-subcortical differentiation of the cortical perisylvian grey matter. Hypoplasia of the corpus callosum. Anomalies of neuronal migration and/or band heterotopia. Increased signal in the subcortical white matter of both temporal poles due to gliosis or malacia. Ventricles in the higher threshold of normality; (f) axial slice from a brain MRI FLAIR sequence of a 6-month-old patient, with a lesion scoring 3. Patchy signal in the white matter of both hemispheres and hemispheric asymmetry, with the right hemisphere being smaller in size and showing associated ventriculomegaly. Loss of cortico-subcortical differentiation and increased sulcation, compatible with polymicrogyria." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Source: Noyola scale<a class="elsevierStyleCrossRef" href="#bib0045">9</a> as modified by Alarcón et al.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>" "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"><th 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" scope="col" style="border-bottom: 2px solid black">Score \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Findings \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \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">None of the following abnormalities \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" 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">Single punctate periventricular calcification, lenticulostriate vasculopathy, caudothalamic germinolysis, ventriculomegaly<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> (excluding severe), and/or focal/multifocal white matter signal abnormality on MRI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" 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">Multiple discrete periventricular calcifications, paraventricular germinolytic cysts, severe ventriculomegaly, diffuse white matter signal abnormality, and/or temporal lobe involvement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" 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">Extensive calcifications, brain atrophy, abnormal gyration, cortical malformation, dysgenesis of the corpus callosum, and/or cerebellar hypoplasia \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2853217.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Ventriculomegaly was defined as axial diameter greater than 10 mm across the atrium at the level of the posterior horns." ] ] ] "descripcion" => array:1 [ "en" => "Modified Noyola scale." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "IUGR: intrauterine growth retardation." "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypoacusia \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">13 patients (36.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IUGR \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">9 patients (25%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microcephalus \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">5 patients (13.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Thrombocytopaenia \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">4 patients (11.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Petechiae \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 patients (8.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hepatosplenomegaly \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 patients (8.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hepatitis \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">1 patient (2.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hyperbilirubinaemia \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">1 patient (2.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chorioretinitis \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">1 patient (2.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2853218.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical symptoms at birth." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "MRI: magnetic resonance imaging." "tablatextoimagen" => array:3 [ 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"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transfontanellar ultrasound; n = 30 (normal, n = 10; alterations, n = 20)</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">White matter alterations \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">8 patients (22.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lenticulostriate vasculopathy \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">8 patients (22.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ventriculomegaly \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">6 patients (16.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Calcifications \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">5 patients (13.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cortical atrophy \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">1 patient (2.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2853219.png" ] ] 1 => 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"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Brain MRI, n = 29 (normal, n = 9; alterations, n = 20)</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">White matter alterations \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">18 patients (50%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cysts \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">9 patients (25%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ventriculomegaly \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">7 patients (19.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vasculopathy \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">6 patients (16.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cortical atrophy \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">4 patients (11.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Calcifications \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 patients (8.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cerebellar atrophy \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">1 patient (2.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2853216.png" ] ] 2 => 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"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Neurological symptoms in patients with brain MRI alterations (n = 20)</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Delayed psychomotor development \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">13 patients (65%) (P = .007) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hearing loss \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">11 patients (55%) (P = .004) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cognitive alterations \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">10 patients (50%) (P = .009) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Speech impairment \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">10 patients (50%) (P = .046) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Seizures \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">1 patient (5%) (P = .495) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chorioretinitis \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">1 patient (5%) (P = .548) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2853220.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Neuroimaging findings." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grupo de estudio de la infección congénita por citomegalovirus de la Sociedad Española de Infectología Pediátrica. Consensus document from the Spanish Society of Paediatric Infectious Diseases (SEIP) on the diagnosis and treatment of congenital cytomegalovirus infection [Article in Spanish]" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Baquero-Artigao" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2009" "volumen" => "71" "paginaInicial" => "535" "paginaFinal" => "547" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Role of cerebral ultrasound and magnetic resonance imaging in newborns with congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.G. Capretti" 1 => "M. Lanari" 2 => "G. Tani" 3 => "G. Ancora" 4 => "R. Sciutti" 5 => "C. Marsico" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.braindev.2013.04.001" "Revista" => array:6 [ "tituloSerie" => "Brain Dev" "fecha" => "2014" "volumen" => "36" "paginaInicial" => "203" "paginaFinal" => "211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23647916" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correlation between white matter lesions and intelligence quotient in patients with congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Inaba" 1 => "M. Motobayashi" 2 => "M. Nishioka" 3 => "T. Kaneko" 4 => "S. Yamauchi" 5 => "Y. Kawasaki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pediatrneurol.2015.11.014" "Revista" => array:6 [ "tituloSerie" => "Pediatr Neurol" "fecha" => "2016" "volumen" => "55" "paginaInicial" => "52" "paginaFinal" => "57" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26778145" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.B. Boppana" 1 => "R.F. Pass" 2 => "W.J. Britt" 3 => "S. Stagno" 4 => "C.A. Alford" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00006454-199202000-00007" "Revista" => array:6 [ "tituloSerie" => "Pediatr Infect Dis J" "fecha" => "1992" "volumen" => "11" "paginaInicial" => "93" "paginaFinal" => "99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1311066" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A wider role for congenital cytomegalovirus infection in sensorineural hearing loss" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Barbi" 1 => "S. Binda" 2 => "S. Caroppo" 3 => "U. Ambrosetti" 4 => "C. Corbetta" 5 => "P. Sergi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00006454-200301000-00012" "Revista" => array:6 [ "tituloSerie" => "Pediatr Infect Dis J" "fecha" => "2003" "volumen" => "22" "paginaInicial" => "39" "paginaFinal" => "42" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12544407" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Progressive hearing loss in infants with asymptomatic congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.D. Williamson" 1 => "G.J. Demmler" 2 => "A.K. Percy" 3 => "F.I. Catlin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "1992" "volumen" => "90" "paginaInicial" => "862" "paginaFinal" => "866" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1331946" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brain magnetic resonance findings in symptomatic congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Manara" 1 => "L. Balao" 2 => "C. Baracchini" 3 => "P. Drigo" 4 => "R. D’Elia" 5 => "E.M. Ruga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Radiol" "fecha" => "2011" "volumen" => "41" "paginaInicial" => "962" "paginaFinal" => "970" "itemHostRev" => array:3 [ "pii" => "S1542356520306807" "estado" => "S300" "issn" => "15423565" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuroradiographic findings in the newborn period and long-term outcome in children with symptomatic congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.B. Boppana" 1 => "K.B. Fowler" 2 => "Y. Vaid" 3 => "G. Hedlund" 4 => "S. Stagno" 5 => "W.J. Britt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.99.3.409" "Revista" => array:6 [ "tituloSerie" => "Pediatrics" "fecha" => "1997" "volumen" => "99" "paginaInicial" => "409" "paginaFinal" => "414" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9041297" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.E. Noyola" 1 => "G.J. Demmler" 2 => "C.T. Nelson" 3 => "C. Griesser" 4 => "W.D. Williamson" 5 => "J.T. Atkins" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr" "fecha" => "2001" "volumen" => "138" "paginaInicial" => "325" "paginaFinal" => "331" "itemHostRev" => array:3 [ "pii" => "S0168827818320658" "estado" => "S300" "issn" => "01688278" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The spectrum of cranial ultrasound and magnetic resonance imaging abnormalities in congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L.S. de Vries" 1 => "H. Gunardi" 2 => "P.G. Barth" 3 => "L.A. Bok" 4 => "M.A. Verboon-Maciolek" 5 => "F. Groenendaal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2004-815833" "Revista" => array:6 [ "tituloSerie" => "Neuropediatrics" "fecha" => "2004" "volumen" => "35" "paginaInicial" => "113" "paginaFinal" => "119" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15127310" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical, biochemical, and neuroimaging findings predict long-term neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Alarcon" 1 => "M. Martinez-Biarge" 2 => "F. Cabanas" 3 => "A. Hernanz" 4 => "J. Quero" 5 => "A. Garcia-Alix" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpeds.2013.06.055" "Revista" => array:4 [ "tituloSerie" => "J Pediatr" "fecha" => "2013" "volumen" => "163" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23958115" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuro-imaging findings in infants with congenital cytomegalovirus infection: relation to trimester of infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Oosterom" 1 => "J. Nijman" 2 => "J. Gunkel" 3 => "T.F. Wolfs" 4 => "F. Groenendaal" 5 => "M.A. Verboon-Maciolek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neonatology" "fecha" => "2015" "volumen" => "107" "paginaInicial" => "289" "paginaFinal" => "296" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Beta2-microglobulin concentrations in cerebrospinal fluid correlate with neuroimaging findings in newborns with symptomatic congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Alarcon" 1 => "A. Garcia-Alix" 2 => "F. Cabanas" 3 => "A. Hernanz" 4 => "D. Pascual-Salcedo" 5 => "A. Martin-Ancel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Pediatr" "fecha" => "2006" "volumen" => "165" "paginaInicial" => "636" "paginaFinal" => "645" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A Prognostic neonatal neuroimaging scale for symptomatic congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Alarcon" 1 => "M. Martinez-Biarge" 2 => "F. Cabanas" 3 => "J. Quero" 4 => "A. Garcia-Alix" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000446690" "Revista" => array:7 [ "tituloSerie" => "Neonatology" "fecha" => "2016" "volumen" => "110" "paginaInicial" => "277" "paginaFinal" => "285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27344149" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016508508016788" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Fernández C, Lorenzo H, Vrotsou K, Aresti U, Rica I, Sánchez E. Estudio de crecimiento de Bilbao. Curvas y tablas de crecimiento (estudio transversal). In: Fundación Faustino Orbegozo Eizaguirre. [Accessed 15 June 2016]. Available from: <a target="_blank" href="https://www.fundacionorbegozo.com/wp-content/uploads/pdf/estudios2011.pdf">https://www.fundacionorbegozo.com/wp-content/uploads/pdf/estudios 2011.pdf</a>." ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "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:5 [ "tituloSerie" => "Pediatr Neurol" "fecha" => "1996" "volumen" => "15" "paginaInicial" => "249" "paginaFinal" => "253" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malformations of cortical development in children with congenital cytomegalovirus infection — a study of nine children with proven congenital cytomegalovirus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V.M. Bosnjak" 1 => "I. Dakovic" 2 => "V. Duranovic" 3 => "L. Lujic" 4 => "G. Krakar" 5 => "B. Marn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Coll Antropol" "fecha" => "2011" "volumen" => "35" "numero" => "Suppl 1" "paginaInicial" => "229" "paginaFinal" => "234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21648339" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infections of the nervous system pediatric neuroimaging" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Barkovich" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "2005" "paginaInicial" => "802" "paginaFinal" => "806" "editorial" => "Lippcott Williams &Wilkins" "editorialLocalizacion" => "Philadelphia" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Thalamic changes in a preterm sample with periventricular leukomalacia: correlation with white-matter integrity and cognitive outcome at school age" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Zubiaurre-Elorza" 1 => "S. Soria-Pastor" 2 => "C. Junque" 3 => "D. Fernandez-Espejo" 4 => "D. Segarra" 5 => "N. Bargallo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/pr.2011.70" "Revista" => array:7 [ "tituloSerie" => "Pediatr Res" "fecha" => "2012" "volumen" => "71" "paginaInicial" => "354" "paginaFinal" => "360" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22391635" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0168827820301264" "estado" => "S300" "issn" => "01688278" ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brain magnetic resonance imaging findings of congenital cytomegalovirus infection as a prognostic factor for neurological outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Kwak" 1 => "M.S. Yum" 2 => "H.R. Yeh" 3 => "H.J. Kim" 4 => "T.S. Ko" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pediatrneurol.2018.03.008" "Revista" => array:7 [ "tituloSerie" => "Pediatr Neurol" "fecha" => "2018" "volumen" => "83" "paginaInicial" => "14" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29681488" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0168827820302786" "estado" => "S300" "issn" => "01688278" ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is lenticulostriated vasculopathy an unfavorable prognostic finding in infants with congenital cytomegalovirus infection?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Giannattasio" 1 => "P. Di Costanzo" 2 => "P. Milite" 3 => "D. De Martino" 4 => "E. Capone" 5 => "A. Romano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcv.2017.04.006" "Revista" => array:6 [ "tituloSerie" => "J Clin Virol" "fecha" => "2017" "volumen" => "91" "paginaInicial" => "31" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28412596" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lenticulostriated vasculopathy is a high-risk marker for hearing loss in congenital cytomegalovirus infections" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Bilavsky" 1 => "M. Schwarz" 2 => "J. Pardo" 3 => "J. Attias" 4 => "I. Levy" 5 => "Y. Haimi-Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Acta Paediatr" "fecha" => "2015" "volumen" => "104" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is lenticulostriated vasculopathy a sign of central nervous system insult in infants with congenital CMV infection?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Amir" 1 => "M. Schwarz" 2 => "I. Levy" 3 => "Y. Haimi-Cohen" 4 => "J. Pardo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/adc.2010.208405" "Revista" => array:7 [ "tituloSerie" => "Arch Dis Child" "fecha" => "2011" "volumen" => "96" "paginaInicial" => "846" "paginaFinal" => "850" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21715394" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1542356514014670" "estado" => "S300" "issn" => "15423565" ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transport, monitoring, and successful brain MR imaging in unsedated neonates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.M. Mathur" 1 => "J.J. Neil" 2 => "R.C. McKinstry" 3 => "T.E. Inder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00247-007-0705-9" "Revista" => array:7 [ "tituloSerie" => "Pediatr Radiol" "fecha" => "2008" "volumen" => "38" "paginaInicial" => "260" "paginaFinal" => "264" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18175110" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2468125320302521" "estado" => "S300" "issn" => "24681253" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurodevelopmental outcomes following ganciclovir therapy in symptomatic congenital cytomegalovirus infections involving the central nervous system" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.E. Oliver" 1 => "G.A. Cloud" 2 => "P.J. Sanchez" 3 => "G.J. Demmler" 4 => "W. Dankner" 5 => "M. Shelton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcv.2009.08.012" "Revista" => array:7 [ "tituloSerie" => "J Clin Virol" "fecha" => "2009" "volumen" => "46" "numero" => "Suppl 4" "paginaInicial" => "S22" "paginaFinal" => "S26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19766534" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Brain magnetic resonance imaging findings of congenital cytomegalovirus infectionas a prognostic factor for neurological outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Kwak" 1 => "M..S. Yum" 2 => "H..R. Yeh" 3 => "H..J. Kim" 4 => "T..S. Ko" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pediatrneurol.2018.03.008" "Revista" => array:6 [ "tituloSerie" => "Pediatr Neurol" "fecha" => "2018" "volumen" => "83" "paginaInicial" => "14" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29681488" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Maturation of white matter in the human brain: a review of magnetic resonance studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Paus" 1 => "D.L. Collins" 2 => "A.C. Evans" 3 => "G. Leonard" 4 => "B. Pike" 5 => "A. Zijdenbos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0361-9230(00)00434-2" "Revista" => array:7 [ "tituloSerie" => "Brain Res Bull" "fecha" => "2001" "volumen" => "54" "paginaInicial" => "255" "paginaFinal" => "266" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11287130" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2468125317301425" "estado" => "S300" "issn" => "24681253" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735808/0000003700000002/v1_202203100608/S2173580821001401/v1_202203100608/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/21735808/0000003700000002/v1_202203100608/S2173580821001401/v1_202203100608/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821001401?idApp=UINPBA00004N"]

Statistics

Original article

Asociación entre neuroimagen y secuelas neurológicas en pacientes con infección congénita por citomegalovirus

M. Escobar Castellanosa,

Corresponding author

mariaescobarcastellanos121091@gmail.com

Corresponding author.

, S. de la Mata Navazoa, M. Carrón Bermejoa, M. García Morína, Y. Ruiz Martínb, J. Saavedra Lozanoc, M.C. Miranda Herreroa, E. Barredo Valderramaa, P. Castro de Castroa, M. Vázquez Lópeza

a Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain

b Sección de Radiología, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain

c Sección de Infectología, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain

Read

2478

Times
was read the article

571

Total PDF

1907

Total HTML

Share statistics

 array:25 [
  "pii" => "S2173580821001401"
  "issn" => "21735808"
  "doi" => "10.1016/j.nrleng.2018.11.011"
  "estado" => "S300"
  "fechaPublicacion" => "2022-03-01"
  "aid" => "1272"
  "copyright" => "Sociedad Espa&#241;ola de Neurolog&#237;a"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Neurologia. 2022;37:122-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:20 [
      "pii" => "S021348531930012X"
      "issn" => "02134853"
      "doi" => "10.1016/j.nrl.2018.11.003"
      "estado" => "S300"
      "fechaPublicacion" => "2022-03-01"
      "aid" => "1272"
      "copyright" => "Sociedad Espa&#241;ola de Neurolog&#237;a"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "fla"
      "cita" => "Neurologia. 2022;37:122-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 947
        "formatos" => array:3 [
          "EPUB" => 50
          "HTML" => 392
          "PDF" => 505
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Asociaci&#243;n entre neuroimagen y secuelas neurol&#243;gicas en pacientes con infecci&#243;n cong&#233;nita por citomegalovirus"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "122"
            "paginaFinal" => "129"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection"
          ]
        ]
        "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" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 2180
                "Ancho" => 1255
                "Tamanyo" => 204448
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Hallazgos de neuroimagen correspondientes a cada estadio de la escala de Noyola et al&#46; modificada&#58; a y b&#41; Corte axial T1 de la RM cerebral y ecograf&#237;a transfontanelar del paciente de 43 d&#237;as de vida&#44; clasificado como grado 1 en la escala de Noyola modificada&#58; se objetiva la presencia de un quiste germinol&#237;tico de 6<span class="elsevierStyleHsp" style=""></span>mm en el surco talamocaudado izquierdo&#44; as&#237; como ventriculomegalia leve del ventr&#237;culo lateral izquierdo&#59; c y d&#41; RM cerebral&#44; corte axial T2&#46; Paciente de 2 meses de vida&#44; clasificado como grado 2&#46; Encefalopat&#237;a multiqu&#237;stica&#59; e&#41; RM cerebral&#44; corte axial T1&#46; Paciente de 4 meses de vida&#44; clasificado como grado 3 en la escala de Noyola modificada&#46; Extensa p&#233;rdida de la diferenciaci&#243;n corticosubcortical de la sustancia gris cortical perisilviana&#46; Hipoplasia del cuerpo calloso&#46; Anomal&#237;as de la migraci&#243;n neuronal y&#47;o heterotopia en banda&#46; Aumento de se&#241;al de la sustancia blanca subcortical de ambos polos temporales por gliosis o malacia&#46; Ventr&#237;culos en el l&#237;mite alto de la normalidad&#44; y f&#41; RM cerebral&#44; corte axial secuencia FLAIR&#46; Paciente de 6 meses&#44; clasificado como grado de 3 en la escala de Noyola modificada&#46; Alteraci&#243;n parcheada de la se&#241;al de la sustancia blanca de ambos hemisferios y asimetr&#237;a hemisf&#233;rica con menor tama&#241;o de hemisferio derecho y ventriculomegalia asociada&#46; P&#233;rdida de la diferenciaci&#243;n c&#243;rtico-subcortical y aumento de la sulcaci&#243;n compatible con polimicrogiria&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Escobar Castellanos, S&#46; de la Mata Navazo, M&#46; Carr&#243;n Bermejo, M&#46; Garc&#237;a Mor&#237;n, Y&#46; Ruiz Mart&#237;n, J&#46; Saavedra Lozano, M&#46;C&#46; Miranda Herrero, E&#46; Barredo Valderrama, P&#46; Castro de Castro, M&#46; V&#225;zquez L&#243;pez"
            "autores" => array:10 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Escobar Castellanos"
              ]
              1 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "de la Mata Navazo"
              ]
              2 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Carr&#243;n Bermejo"
              ]
              3 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Garc&#237;a Mor&#237;n"
              ]
              4 => array:2 [
                "nombre" => "Y&#46;"
                "apellidos" => "Ruiz Mart&#237;n"
              ]
              5 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Saavedra Lozano"
              ]
              6 => array:2 [
                "nombre" => "M&#46;C&#46;"
                "apellidos" => "Miranda Herrero"
              ]
              7 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Barredo Valderrama"
              ]
              8 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "Castro de Castro"
              ]
              9 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "V&#225;zquez L&#243;pez"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173580821001401"
          "doi" => "10.1016/j.nrleng.2018.11.011"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821001401?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S021348531930012X?idApp=UINPBA00004N"
      "url" => "/02134853/0000003700000002/v2_202203180842/S021348531930012X/v2_202203180842/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S2173580820300705"
    "issn" => "21735808"
    "doi" => "10.1016/j.nrleng.2018.04.002"
    "estado" => "S300"
    "fechaPublicacion" => "2022-03-01"
    "aid" => "1222"
    "copyright" => "Sociedad Espa&#241;ola de Neurolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "rev"
    "cita" => "Neurologia. 2022;37:130-5"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>"
      "titulo" => "Controversies in cerebrovascular disease&#58; high or low doses of recombinant tissue plasminogen activator to treat acute stroke&#63; A literature review"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "130"
          "paginaFinal" => "135"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Controversias en enfermedad cerebrovascular&#58; rt-PA a dosis bajas vs&#46; dosis est&#225;ndar en el tratamiento del ictus agudo&#46; Una revisi&#243;n de la literatura"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "V&#46; Montalv&#225;n Ayala, Z&#46; Rojas Cheje, R&#46; Aldave Salazar"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Montalv&#225;n Ayala"
            ]
            1 => array:2 [
              "nombre" => "Z&#46;"
              "apellidos" => "Rojas Cheje"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Aldave Salazar"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0213485318301452"
        "doi" => "10.1016/j.nrl.2018.04.003"
        "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/S0213485318301452?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580820300705?idApp=UINPBA00004N"
    "url" => "/21735808/0000003700000002/v1_202203100608/S2173580820300705/v1_202203100608/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S2173580821000109"
    "issn" => "21735808"
    "doi" => "10.1016/j.nrleng.2018.10.022"
    "estado" => "S300"
    "fechaPublicacion" => "2022-03-01"
    "aid" => "1273"
    "copyright" => "Sociedad Espa&#241;ola de Neurolog&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Neurologia. 2022;37:110-21"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Peripheral blood lymphocyte phenotypes in Alzheimer and Parkinson&#8217;s diseases"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "110"
          "paginaFinal" => "121"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Fenotipos de linfocitos perif&#233;ricos en las enfermedades de Alzheimer y Parkinson"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1906
              "Ancho" => 1500
              "Tamanyo" => 121452
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Fig&#46; "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Proportion of memory T cells in patients with Alzheimer disease &#40;A&#41; and patients with Parkinson&#8217;s disease &#40;B&#41;&#44; compared to healthy controls &#40;HC&#41;&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">&#42; <span class="elsevierStyleItalic">P</span>-value between &#46;01 and &#46;05&#46;</p> <p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42; <span class="elsevierStyleItalic">P</span>-value between &#46;0001 and &#46;01&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42;&#42; <span class="elsevierStyleItalic">P</span>-value &#60; &#46;0001&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "S&#46; Garfias, B&#46; Tamaya Dom&#237;nguez, A&#46; Toledo Rojas, M&#46; Arroyo, U&#46; Rodr&#237;guez, C&#46; Boll, A&#46;L&#46; Sosa, E&#46; Sciutto, L&#46; Adalid-Peralta, Y&#46; Martinez L&#243;pez, G&#46; Fragoso, A&#46; Fleury"
          "autores" => array:12 [
            0 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Garfias"
            ]
            1 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Tamaya Dom&#237;nguez"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Toledo Rojas"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Arroyo"
            ]
            4 => array:2 [
              "nombre" => "U&#46;"
              "apellidos" => "Rodr&#237;guez"
            ]
            5 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Boll"
            ]
            6 => array:2 [
              "nombre" => "A&#46;L&#46;"
              "apellidos" => "Sosa"
            ]
            7 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Sciutto"
            ]
            8 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Adalid-Peralta"
            ]
            9 => array:2 [
              "nombre" => "Y&#46;"
              "apellidos" => "Martinez L&#243;pez"
            ]
            10 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Fragoso"
            ]
            11 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Fleury"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0213485319300131"
        "doi" => "10.1016/j.nrl.2018.10.004"
        "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/S0213485319300131?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821000109?idApp=UINPBA00004N"
    "url" => "/21735808/0000003700000002/v1_202203100608/S2173580821000109/v1_202203100608/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "122"
        "paginaFinal" => "129"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46; Escobar Castellanos, S&#46; de la Mata Navazo, M&#46; Carr&#243;n Bermejo, M&#46; Garc&#237;a Mor&#237;n, Y&#46; Ruiz Mart&#237;n, J&#46; Saavedra Lozano, M&#46;C&#46; Miranda Herrero, E&#46; Barredo Valderrama, P&#46; Castro de Castro, M&#46; V&#225;zquez L&#243;pez"
        "autores" => array:10 [
          0 => array:4 [
            "nombre" => "M&#46;"
            "apellidos" => "Escobar Castellanos"
            "email" => array:1 [
              0 => "mariaescobarcastellanos121091@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "de la Mata Navazo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Carr&#243;n Bermejo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Garc&#237;a Mor&#237;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Y&#46;"
            "apellidos" => "Ruiz Mart&#237;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Saavedra Lozano"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "M&#46;C&#46;"
            "apellidos" => "Miranda Herrero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Barredo Valderrama"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "Castro de Castro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "V&#225;zquez L&#243;pez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Secci&#243;n de Neuropediatr&#237;a&#44; Hospital Materno Infantil Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Secci&#243;n de Radiolog&#237;a&#44; Hospital Materno Infantil Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Secci&#243;n de Infectolog&#237;a&#44; Hospital Materno Infantil Gregorio Mara&#241;&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Asociaci&#243;n entre neuroimagen y secuelas neurol&#243;gicas en pacientes con infecci&#243;n cong&#233;nita por citomegalovirus"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3776
            "Ancho" => 2174
            "Tamanyo" => 712188
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Neuroimaging findings corresponding to the stages of the modified Noyola classification&#59; &#40;a and b&#41; axial slices from T1-weighted brain MRI and transfontanellar ultrasound studies of a 43-day-old patient&#44; scoring 1 on the classification&#46; It shows the presence of a 6-mm germinolytic cyst in the left caudothalamic groove&#44; as well as mild ventriculomegaly of the left lateral ventricle&#59; &#40;c and d&#41; axial slices from T2-weighted brain MRI of a 2-month-old patient&#44; with lesions scoring 2&#46; Multicystic encephalopathy&#59; &#40;e&#41; axial slice from a T1-weighted brain MRI scan of a 4-month-old patient&#44; with a lesion scoring 3&#46; Extensive loss of cortico-subcortical differentiation of the cortical perisylvian grey matter&#46; Hypoplasia of the corpus callosum&#46; Anomalies of neuronal migration and&#47;or band heterotopia&#46; Increased signal in the subcortical white matter of both temporal poles due to gliosis or malacia&#46; Ventricles in the higher threshold of normality&#59; &#40;f&#41; axial slice from a brain MRI FLAIR sequence of a 6-month-old patient&#44; with a lesion scoring 3&#46; Patchy signal in the white matter of both hemispheres and hemispheric asymmetry&#44; with the right hemisphere being smaller in size and showing associated ventriculomegaly&#46; Loss of cortico-subcortical differentiation and increased sulcation&#44; compatible with polymicrogyria&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Congenital cytomegalovirus &#40;CMV&#41; infection is one of the most frequent prenatal infections in developed countries&#44; affecting between 0&#46;3&#37; and 0&#46;6&#37; of newborns in Europe&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is the most frequent cause of delayed psychomotor development and hearing loss of infectious origin&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Only 10&#37; of newborns with the infection will present symptoms at birth &#40;intrauterine growth retardation&#44; hepatosplenomegaly&#44; thrombocytopaenia&#44; jaundice&#44; petechiae&#44; microcephalus&#44; or abnormal neurological examination findings&#41;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#59; 90&#37; of neonates are asymptomatic&#44; although 13&#37; of these patients will present sequelae throughout their lives&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The central nervous system &#40;CNS&#41; is affected in 50&#37; of children with symptomatic infection&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> leading to alterations in psychomotor development&#44; sensorineural hearing loss&#44; and chorioretinitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Neuroimaging studies of these patients only detect alterations in two-thirds of cases&#59; the most frequent alterations are presence of cerebral calcifications&#44; ventriculomegaly&#44; periventricular white matter alterations&#44; neuronal migration disorders&#44; cortical atrophy&#44; periventricular cysts&#44; and cerebellar hypoplasia&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Most studies on brain involvement in congenital CMV infection are based on computed tomography &#40;CT&#41; findings&#59; however&#44; this technique causes ionising radiation and is not superior to ultrasound for detecting ventriculomegaly&#44; subependymal cysts&#44; calcifications&#44; or lenticulostriate vasculopathy &#40;LSV&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;7&#44;10&#8211;13</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Recent studies have aimed to establish the prognostic role of transfontanellar ultrasound and magnetic resonance imaging &#40;MRI&#41; in cerebral involvement of congenital CMV infection&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> However&#44; further studies are needed to determine the precise prognostic role of brain MRI&#44; especially in patients with white matter lesions&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of this study is to analyse the relationship between imaging alterations &#40;prenatal ultrasound&#44; transfontanellar ultrasound and MRI&#41; and neurological involvement in patients with congenital CMV infection&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">We conducted an observational&#44; retrospective&#44; analytical study in the paediatric neurology department in collaboration with the paediatric radiology and the paediatric infectious diseases department at a tertiary hospital in the Region of Madrid &#40;Spain&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study period was from January 2003 to August 2017&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We included patients under follow-up by the paediatric neurology department and diagnosed with congenital CMV infection&#46; This department follows up all patients with confirmed infection&#44; whether symptomatic or asymptomatic&#46; Congenital CMV infection was confirmed by positive PCR or urine culture findings for CMV in the first 15 days of life or positive PCR for CMV in dried blood spots &#40;Guthrie card&#41; from the first 48&#160;hours of life&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Infection was considered symptomatic at birth when patients presented&#58; intrauterine growth retardation &#40;defined as weight at birth more than 2 standard deviations &#91;SD&#93; below the mean&#41;&#44; petechiae&#44; hepatomegaly&#44; splenomegaly&#44; microcephalus &#40;defined as head circumference at birth more than 2 SD below the mean&#41;&#44; sensorineural hearing loss &#40;altered otoacoustic emissions&#44; confirmed by auditory evoked potentials&#41;&#44; chorioretinitis&#44; thrombocytopaenia &#40;less than 100 000 platelets&#47;&#956;L&#41;&#44; elevated liver enzymes &#40;alanine transferase &#62; 100&#160;U&#47;L &#91;normal range&#58; 5-50&#160;U&#47;L&#93;&#41;&#44; or cholestasis &#40;direct bilirubin &#62; 3&#160;mg&#47;dL &#91;normal range&#58; 0-0&#46;3&#160;mg&#47;dL&#93;&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Neuroimaging studies and score</span><p id="par0060" class="elsevierStylePara elsevierViewall">Pathological brain ultrasound findings were defined as intracranial calcifications&#44; ventriculomegaly &#40;axial diameter greater than 10&#160;mm across the atrium at the level of the posterior horns&#41;&#44; germinolytic cysts&#44; and&#47;or lenticulostriate vasculopathy&#46; The ultrasound devices used were the Toshiba Xario and Aplio systems&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the brain MRI study&#44; we obtained sagittal&#44; axial&#44; and coronal slices in T1- and T2-weighted sequences with a 1&#46;5 T scanner&#46; A paediatric radiologist interpreted the images&#46; A second paediatric radiologist reviewed the images&#44; assigning a severity score according to the modified version<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> of the Noyola scoring scale&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Neurodevelopmental evaluation</span><p id="par0070" class="elsevierStylePara elsevierViewall">Neurological involvement was assessed in the last consultation and was considered to include the following items&#58; microcephalus &#40;head circumference at birth more than 2 SD below the mean according to the tables published by Fern&#225;ndez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#41;&#44; psychomotor retardation according to the Denver scale &#40;as assessed by an experienced paediatric neurologist&#41;&#44; motor alterations &#40;classified as mild&#44; moderate&#44; or severe&#41;&#44; behavioural alterations&#44; cognitive alterations&#44; speech impairment&#44; and seizures&#46; Presence of hearing alterations &#40;losses greater than 20&#160;dB&#41; and chorioretinitis was also assessed&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Qualitative variables are expressed as numbers and percentages&#46; Continuous variables are expressed as mean&#160;&#177;&#160;SD for normally distributed data and median&#160;&#177;&#160;interquartile range for non&#8211;normally distributed data&#46; We used the chi-square test or the Fisher exact test to compare qualitative variables and the <span class="elsevierStyleItalic">t</span> test or Mann&#8211;Whitney U test to compare continuous variables&#46; Statistical analysis was conducted using SPSS&#174;&#46; <span class="elsevierStyleItalic">P</span> values &#60; &#46;05 were considered significant&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">Of a total of 36 patients&#44; 17 &#40;47&#46;2&#37;&#41; were boys&#46; Six patients &#40;16&#46;7&#37;&#41; were born preterm and 10 &#40;27&#37;&#41; presented low birth weight&#46; Mean birth weight was 2775&#46;6&#160;g&#160;&#177;&#160;622&#46;8 and mean head circumference at birth was 33&#46;1&#160;cm&#160;&#177;&#160;2&#46;0&#46; Eight patients &#40;22&#37;&#41; presented microcephalus at birth&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Congenital CMV infection was suspected before birth in 24 patients &#40;66&#46;7&#37;&#41;&#46; We observed alterations in prenatal ultrasound studies of 13 patients &#40;36&#37;&#41;&#59; the main findings were intrauterine growth retardation and ventriculomegaly observed during the third trimester&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Twenty patients &#40;55&#46;6&#37;&#41; presented symptoms compatible with congenital CMV infection at birth&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> lists the most frequent clinical manifestations&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Antiviral treatment &#40;oral valganciclovir&#41; was administered to 20 patients &#40;55&#46;6&#37;&#41;&#46; Sixteen of the 24 patients in whom CMV infection was suspected before birth &#40;66&#46;7&#37;&#41; started treatment before one month of life&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The most recent follow-up consultation in the paediatric neurology clinic was performed when patients had a mean age of 49&#46;6&#160;&#177;&#160;40&#46;0 months &#40;4 years&#41;&#46; Eighteen patients &#40;50&#37;&#41; were asymptomatic and the remaining 18 presented neurological sequelae&#58; 15 patients &#40;41&#46;7&#37;&#41; showed psychomotor retardation&#44; which was severe in only 2 cases&#46; Eleven patients &#40;30&#37;&#41; presented cognitive alterations and 12 &#40;33&#37;&#41; presented speech impairment&#46; Only 2 patients &#40;5&#46;6&#37;&#41; presented seizures&#46; Twelve patients &#40;33&#46;3&#37;&#41; had hearing alterations&#44; with 3 &#40;25&#37;&#41; requiring cochlear implants&#46; Two patients &#40;5&#46;6&#37;&#41; presented visual disturbances due to chorioretinitis&#46; None of the 36 patients died during the study period&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Fifteen of the patients with neurological alterations in the last follow-up consultation &#40;83&#46;3&#37;&#41; presented symptoms at birth &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;001&#41;&#46; Ten &#40;55&#46;6&#37;&#41; presented alterations in the transfontanellar ultrasound performed in the first months of life &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;013&#41; and 16 &#40;88&#46;9&#37;&#41; presented abnormal brain MRI findings &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;001&#41;&#46;</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Neuroimaging techniques</span><p id="par0110" class="elsevierStylePara elsevierViewall">All patients underwent at least one imaging study &#40;transfontanellar ultrasound&#44; brain MRI&#44; or both&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The main neuroimaging findings are detailed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Prenatal ultrasound and MRI</span><p id="par0120" class="elsevierStylePara elsevierViewall">Thirteen patients presented anomalies compatible with congenital CMV infection in the prenatal ultrasound&#46; Of these patients&#44; 11 &#40;84&#46;6&#37;&#41; presented symptoms at birth &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;008&#41;&#46; Ten &#40;79&#46;6&#37;&#41; subsequently presented alterations in the brain MRI study &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;07&#41;&#46; Twelve patients with alterations compatible with congenital CMV infection in the prenatal ultrasound &#40;92&#46;3&#37;&#41; presented neurological alterations in the most recent neurology follow-up consultation &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;001&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Four patients underwent a prenatal MRI study&#44; with 3 showing alterations &#40;ventriculomegaly&#44; cortical atrophy&#44; and&#47;or white matter alterations&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Transfontanellar ultrasound</span><p id="par0130" class="elsevierStylePara elsevierViewall">Transfontanellar ultrasound studies were performed in 30 patients &#40;83&#46;3&#37;&#41;&#44; and alterations were detected in 20 &#40;66&#37;&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Eleven patients &#40;55&#37;&#41; in the latter group had presented symptoms compatible with congenital CMV infection at birth &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;024&#41;&#46; Also&#44; 11 &#40;55&#37;&#41; of these patients presented brain MRI anomalies &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;044&#41;&#44; which were severe in 50&#37;&#46; Eight of the 10 patients with normal transfontanellar ultrasound findings presented normal psychomotor development &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;003&#41;&#46; Ten of the 20 patients showing alterations in the transfontanellar ultrasound presented delayed psychomotor development &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;001&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">LSV was observed in 8 of the 30 transfontanellar ultrasounds&#46; No association was identified between presence of LSV and symptoms at birth &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;108&#41;&#59; of the 8 patients with LSV&#44; 5 &#40;62&#46;5&#37;&#41; presented delayed psychomotor development &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;045&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">As a predictor of neurological sequelae&#44; transfontanellar ultrasound presented a sensitivity of 83&#46;3&#37;&#44; &#40;90&#37; CI&#44; 58-100&#41;&#44; specificity of 44&#46;4&#37; &#40;90&#37; CI&#44; 18&#46;7-70&#46;2&#41;&#44; positive predictive value of 50&#37; &#40;90&#37; CI&#44; 25&#46;6-74&#46;4&#41;&#44; and a negative predictive value of 80&#37; &#40;90&#37; CI&#44; 50&#46;2-100&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Brain MRI</span><p id="par0150" class="elsevierStylePara elsevierViewall">Brain MRI studies were performed in 29 patients &#40;80&#37;&#41;&#44; at a mean age of 19&#46;25 months &#40;0&#46;23-111&#46;41&#41;&#46; MRI detected alterations in 19 patients &#40;70&#37;&#41;&#59; the most frequent alterations are detailed in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">A positive correlation was identified between brain MRI alterations&#44; presence of symptoms at birth&#44; and the presence of neurological alterations&#46; Thirteen patients with brain MRI alterations compatible with congenital CMV infection &#40;68&#46;4&#37;&#41; had presented symptoms at birth &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;25&#41;&#46; Sixteen patients with brain MRI alterations &#40;84&#46;2&#37;&#41; presented neurological alterations in the last follow-up consultation at the paediatric neurology clinic &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;001&#41;&#59; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> lists the main neurological deficits detected&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">According to the modified Noyola classification&#44; 14 patients &#40;38&#46;9&#37;&#41; presented alterations scoring 0&#44; 6 patients &#40;16&#46;6&#37;&#41; had alterations scoring 1&#44; 12 patients &#40;33&#46;3&#37;&#41; had alterations scoring 2&#44; and 4 patients &#40;11&#46;1&#37;&#41; had alterations scoring 3&#59; a positive correlation was observed between presence of severe alterations in neuroimaging studies and neurological involvement&#58; all 4 of the patients with alterations scoring 3 presented delayed psychomotor development &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;002&#41; and cognitive alterations &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;001&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">MRI alterations scoring 2 or 3 were observed in 12 of the 18 patients &#40;66&#37;&#41; with delayed psychomotor development &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;001&#41;&#44; in all 6 patients with behavioural alterations &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;003&#41;&#44; 10 of the 11 patients &#40;90&#37;&#41; with cognitive alterations &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;001&#41;&#44; 10 of the 12 patients &#40;83&#37;&#41; with speech impairment &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;001&#41;&#44; and 10 of the 12 patients &#40;83&#37;&#41; with hearing loss &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;001&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">MRI showed a sensitivity of 94&#37; &#40;95&#37; CI&#44; 80-100&#41;&#44; specificity of 66&#46;6&#37; &#40;95&#37; CI&#44; 36-97&#46;5&#41;&#44; a positive predictive value of 80&#37; &#40;95&#37; CI&#44; 60-100&#41;&#44; and a negative predictive value of 88&#37; &#40;95&#37; CI&#44; 68-100&#41;&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Discussion</span><p id="par0175" class="elsevierStylePara elsevierViewall">Infection with CMV during the prenatal period may cause a wide variety of neurodevelopmental alterations&#44; which differ according to the trimester in which the infection occurred&#46; Infection early in gestation may give rise to significant CNS malformations including lissencephaly&#44; polymicrogyria&#44; schizencephaly&#44; calcifications&#44; cerebellar hypoplasia&#44; and&#47;or hypoplasia&#47;agenesis of the corpus callosum&#46; Infection during the last months of gestation provokes less prominent alterations&#44; such as white matter alterations or myelination disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">Although head CT studies are useful for detecting some alterations associated with neurodevelopmental retardation in these patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;16&#44;18</span></a> they do not constitute the best tool for detecting neuronal migration disorders or white matter alterations&#59; patients are also exposed to high levels of ionising radiation&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Head CT scans were not performed in any of the patients of our study&#59; ours is the first study in which all patients diagnosed with congenital CMV infection were studied with transfontanellar ultrasound&#44; MRI&#44; or both&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In the neonatal period&#44; MRI and ultrasound are the techniques of choice for detecting such brain alterations as periventricular cysts&#44; cerebellar hypoplasia&#44; and hippocampal dysplasia&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> There is growing interest in the prognostic role of MRI for congenital CMV infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;11&#44;14&#44;19</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Establishing a precise&#44; early diagnosis of the risk of neurodevelopmental alterations helps us to correctly advise parents and to personalise the follow-up and treatment of each patient&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Transfontanellar ultrasound is a very useful tool for assessing the typical findings of brain involvement in congenital CMV infection&#44; such as ventriculomegaly&#44; periventricular cysts&#44; and cerebral calcifications&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Furthermore&#44; it does not expose patients to radiation or require sedation&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;10&#44;20</span></a> The study by Alarc&#243;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> confirms that transfontanellar ultrasound is comparable to CT in terms of its capacity to detect most of the cerebral lesions caused by CMV&#44; and shows that the Noyola classification&#44; originally designed for CT scans&#44; is also applicable to transfontanellar ultrasound findings&#46; As in our study&#44; the presence of alterations scoring 2-3 presented a high predictive value for association with alterations in psychomotor development&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The role of transfontanellar ultrasound findings&#44; and especially the presence of LSV&#44; has been widely studied&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;23</span></a> In our study&#44; transfontanellar ultrasound was performed in 83&#46;3&#37; of patients&#59; we observed that most patients with normal findings presented adequate neurodevelopment&#44; whereas neurodevelopmental alterations were observed in approximately half of patients presenting alterations in the transfontanellar ultrasound&#46; These findings contrast with those obtained by Capretti et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> who identified a correlation between neuroimaging and neurological assessment findings in 40 patients with congenital CMV infection&#44; with transfontanellar ultrasound showing a sensitivity of 57&#37;&#46; However&#44; this may be explained by the fact that such findings as mild ventriculomegaly or LSV were not considered pathological&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Furthermore&#44; the role of LSV as an ultrasound finding in congenital CMV infection is debated&#46; In the study by Giannattasio et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> LSV was not associated with poor prognosis&#44; with neurodevelopmental alterations reported in 39&#37; of patients with LSV and 54&#37; of those who did not present this alteration&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> These data are consistent with the results of our study&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The prospective study by Alarc&#243;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> included 26 patients with congenital CMV&#44; and concluded that normal transfontanellar ultrasound findings are sufficient to predict favourable neurological development&#46; However&#44; our study included 2 patients with normal transfontanellar ultrasound findings and neurodevelopmental alterations&#59; therefore&#44; brain MRI was necessary to rule out brain involvement in patients diagnosed with congenital CMV infection&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Some studies have shown that MRI provides additional information in 20&#37; of cases&#44; especially in the diagnosis of brain developmental disorders<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> such as temporal lobe lesions&#44; cortical malformations&#44; and white matter alterations&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However&#44; few studies have demonstrated the association between neurological prognosis and transfontanellar ultrasound and MRI alterations in patients with congenital CMV infection&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">White matter alterations are frequently the only manifestation of CMV infection&#44; and may be related to psychomotor development alterations&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;24&#44;25</span></a> In our study&#44; 75&#37; of patients underwent MRI studies&#44; with white matter alterations being the most frequent alteration detected&#44; followed by periventricular cysts&#46; Of these patients&#44; 84&#46;2&#37; presented neurological alterations in the last follow-up consultation at the paediatric neurology clinic&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">The study by Kwak et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> found that the volume of white matter affected in the brain MRI scan performed at 2 years was associated with intelligence quotient scores&#46; However&#44; white matter lesions are sometimes difficult to distinguish from delayed myelination&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;27</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Periventricular cysts are suggestive of viral infection due to the vulnerability of the germinal matrix to infection&#58; in our study&#44; 25&#37; of patients undergoing MRI presented germinolytic cysts&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Our results are similar to those reported by Alarc&#243;n et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> showing a positive correlation between the severity of neuroimaging alterations and neurological involvement&#46; Furthermore&#44; the presence of alterations scoring 2-3 on the Noyola classification presented a high predictive value for the association with alterations in psychomotor development&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">Establishing a precise&#44; early diagnosis of the risk of neurodevelopmental alterations helps us to correctly advise parents and to personalise the follow-up and treatment of each patient&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">The strength of our study lies in the inclusion of both symptomatic and asymptomatic patients&#44; with imaging studies performed in all cases&#46; Furthermore&#44; patients were followed up for a long period of time &#40;the oldest patient was 14&#46;3 years old&#41;&#46; The main limitations were the exclusion of patients with congenital CMV infection who were not followed up at the paediatric neurology clinic&#44; which may have led to bias&#44; with the series including patients with more severe neurological involvement&#46; Furthermore&#44; as brain MRI was not performed at a specific age&#44; some lesions may have been misinterpreted as immature myelination&#46; Lesion progression could not be observed as serial MRI studies were not conducted&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusions</span><p id="par0245" class="elsevierStylePara elsevierViewall">Based on our findings&#44; we can establish a series of recommendations for the follow-up of these patients&#46; It would be recommendable to perform transfontanellar ultrasound studies at birth and to complement the study with brain MRI and start treatment if alterations are detected&#46; If transfontanellar ultrasound findings are normal&#44; an MRI scan should be performed at 4 weeks&#44; with a further brain MRI scan at 2 years to be considered in all patients with congenital CMV infection&#46; Follow-up should continue during the school stage&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding</span><p id="par0250" class="elsevierStylePara elsevierViewall">This study received no public or private funding&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0255" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:12 [
        0 => array:3 [
          "identificador" => "xres1677652"
          "titulo" => "Abstract"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Aim"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Patients and methods"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Results"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1488035"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1677651"
          "titulo" => "Resumen"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Objetivo"
            ]
            2 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Pacientes y m&#233;todos"
            ]
            3 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Resultados"
            ]
            4 => array:2 [
              "identificador" => "abst0050"
              "titulo" => "Conclusi&#243;n"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1488034"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Patients and methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Neuroimaging studies and score"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Neurodevelopmental evaluation"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Results"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Neuroimaging techniques"
            ]
            1 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Prenatal ultrasound and MRI"
            ]
            2 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Transfontanellar ultrasound"
            ]
            3 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Brain MRI"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Conflicts of interest"
        ]
        11 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-07-19"
    "fechaAceptado" => "2018-11-15"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1488035"
          "palabras" => array:12 [
            0 => "Calcification"
            1 => "Cytomegalovirus"
            2 => "Congenital"
            3 => "Ultrasound"
            4 => "Neuroimaging"
            5 => "Paediatrics"
            6 => "Prognosis"
            7 => "Magnetic resonance imaging"
            8 => "Psychomotor retardation"
            9 => "Sensorineural deafness"
            10 => "Ventriculomegaly"
            11 => "Periventricular cysts"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1488034"
          "palabras" => array:12 [
            0 => "Calcificaciones"
            1 => "Citomegalovirus"
            2 => "Cong&#233;nito"
            3 => "Ecograf&#237;a"
            4 => "Neuroimagen"
            5 => "Pediatr&#237;a"
            6 => "Pron&#243;stico"
            7 => "Resonancia magn&#233;tica"
            8 => "Retraso psicomotor"
            9 => "Sordera neurosensorial"
            10 => "Ventriculomegalia"
            11 => "Quistes periventriculares"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Congenital cytomegalovirus &#40;CMV&#41; infection is an important cause of disability&#46; There is little evidence on the prognostic value of lesions identified in neuroimaging studies&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Aim</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Patients and methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective&#44; analytical&#44; observational study of 36 patients with congenital CMV infection&#46; Neuroimaging studies were reviewed and classified according to the modified Noyola&#8217; scale&#46; Imaging findings were compared with neurological alterations in the patients&#8217; most recent follow-up evaluation at the paediatric neurology department&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Thirty-six patients were studied &#40;transfontanellar ultrasound&#58; 30&#59; brain MRI&#58; 29&#41;&#46; Twenty of 30 patients showed ultrasound abnormalities&#59; of these&#44; 11 showed alterations on brain MR images &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;04&#41; and 10 had neurological impairment &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;008&#41;&#46; Transfontanellar ultrasound had a sensitivity of 83&#46;3&#37;&#44; 90&#37; CI&#58; 58-100 and a specificity of 44&#46;4&#37;&#44; 90&#37; CI&#58; 18&#46;7-70&#46;2 for predicting neurological sequelae&#46; Brain MRI displayed abnormalities in 20 of 29 patients&#44; of whom 16 had neurological impairment &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;001&#41;&#46; MRI had a sensitivity of 94&#37;&#44; 95&#37; CI&#58; 80-100 and a specificity of 66&#46;6&#37;&#44; 95&#37; CI&#58; 36-97&#46;5 for predicting neurological sequelae&#46; Modified Noyola&#8217; scale values &#62; 2 were correlated with psychomotor retardation &#40;<span class="elsevierStyleItalic">P</span>&#160;&#60;&#160;&#46;001&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Aim"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Patients and methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La infecci&#243;n cong&#233;nita por citomegalovirus &#40;CMV&#41; supone una importante causa de discapacidad&#46; Existen escasas evidencias acerca del valor pron&#243;stico de las lesiones presentes en los estudios de neuroimagen&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Analizar la gravedad de las lesiones en la resonancia magn&#233;tica &#40;RM&#41; y la ecograf&#237;a transfontanelar y su relaci&#243;n con d&#233;ficits neurol&#243;gicos a largo plazo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Pacientes y m&#233;todos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio observacional anal&#237;tico retrospectivo de 36 pacientes con infecci&#243;n cong&#233;nita por CMV&#46; Se revisaron los estudios de neuroimagen y se clasificaron seg&#250;n la escala de Noyola et al&#46; modificada&#46; Se relacionaron los hallazgos de neuroimagen con la afectaci&#243;n neurol&#243;gica en su &#250;ltima visita en la consulta de neuropediatr&#237;a&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Un total de 36 pacientes fueron estudiados&#44; habi&#233;ndose realizado ecograf&#237;a transfontanelar en 30 y RM cerebral en 29&#46; La ecograf&#237;a transfontanelar estuvo alterada en 20&#47;30 pacientes&#44; de los cuales&#44; 11 tuvieron alteraci&#243;n en la RM &#40;p&#160;&#61;&#160;0&#44;04&#41; y 10 afectaci&#243;n neurol&#243;gica &#40;p&#160;&#61;&#160;0&#44;008&#41;&#46; Tuvo una sensibilidad del 83&#44;3&#37;&#44; IC 90&#37;&#58; 58&#8211;100 y una especificidad del 44&#44;4&#37;&#44; IC 90&#37;&#58; 18&#44;7&#8211;70&#44;2 para la predicci&#243;n de secuelas neurol&#243;gicas&#46; La RM estuvo alterada en 20&#47;29 pacientes&#46; Diecis&#233;is de ellos tuvieron afectaci&#243;n neurol&#243;gica &#40;p&#160;&#60;&#160;0&#44;001&#41;&#44; teniendo una sensibilidad del 94&#37;&#44; IC 95&#37;&#58; 80&#8211;100 y una especificidad del 66&#44;6&#37;&#44; IC 95&#37;&#58; 36&#8211;97&#44;5 para la predicci&#243;n de secuelas neurol&#243;gicas&#46; Una escala de Noyola et al&#46; &#8805; 2 se asoci&#243; a retraso psicomotor &#40;p&#160;&#60;&#160;0&#44;001&#41;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Nuestro trabajo valida los estudios previos en los que se encuentra correlaci&#243;n estad&#237;sticamente significativa entre la extensi&#243;n de las lesiones en neuroimagen y la gravedad de los d&#233;ficits neurol&#243;gicos&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Pacientes y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Escobar Castellanos M&#44; de la Mata Navazo S&#44; Carr&#243;n Bermejo M&#44; Garc&#237;a Mor&#237;n M&#44; Ruiz Mart&#237;n Y&#44; Saavedra Lozano J&#44; et al&#46; Asociaci&#243;n entre neuroimagen y secuelas neurol&#243;gicas en pacientes con infecci&#243;n cong&#233;nita por citomegalovirus&#46; Neurolog&#237;a&#46; 2022&#59;37&#58;122&#8211;129&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">This study was presented as an oral communication at the 41st Annual Meeting of the Spanish Society of Paediatric Neurology &#40;SENEP&#41; in Girona&#44; 14&#8211;16 June 2018&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 3776
            "Ancho" => 2174
            "Tamanyo" => 712188
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Neuroimaging findings corresponding to the stages of the modified Noyola classification&#59; &#40;a and b&#41; axial slices from T1-weighted brain MRI and transfontanellar ultrasound studies of a 43-day-old patient&#44; scoring 1 on the classification&#46; It shows the presence of a 6-mm germinolytic cyst in the left caudothalamic groove&#44; as well as mild ventriculomegaly of the left lateral ventricle&#59; &#40;c and d&#41; axial slices from T2-weighted brain MRI of a 2-month-old patient&#44; with lesions scoring 2&#46; Multicystic encephalopathy&#59; &#40;e&#41; axial slice from a T1-weighted brain MRI scan of a 4-month-old patient&#44; with a lesion scoring 3&#46; Extensive loss of cortico-subcortical differentiation of the cortical perisylvian grey matter&#46; Hypoplasia of the corpus callosum&#46; Anomalies of neuronal migration and&#47;or band heterotopia&#46; Increased signal in the subcortical white matter of both temporal poles due to gliosis or malacia&#46; Ventricles in the higher threshold of normality&#59; &#40;f&#41; axial slice from a brain MRI FLAIR sequence of a 6-month-old patient&#44; with a lesion scoring 3&#46; Patchy signal in the white matter of both hemispheres and hemispheric asymmetry&#44; with the right hemisphere being smaller in size and showing associated ventriculomegaly&#46; Loss of cortico-subcortical differentiation and increased sulcation&#44; compatible with polymicrogyria&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Noyola scale<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> as modified by Alarc&#243;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></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"><th 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" scope="col" style="border-bottom: 2px solid black">Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th 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" scope="col" style="border-bottom: 2px solid black">Findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\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">None of the following abnormalities&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\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">Single punctate periventricular calcification&#44; lenticulostriate vasculopathy&#44; caudothalamic germinolysis&#44; ventriculomegaly<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;excluding severe&#41;&#44; and&#47;or focal&#47;multifocal white matter signal abnormality on MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\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">Multiple discrete periventricular calcifications&#44; paraventricular germinolytic cysts&#44; severe ventriculomegaly&#44; diffuse white matter signal abnormality&#44; and&#47;or temporal lobe involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\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">Extensive calcifications&#44; brain atrophy&#44; abnormal gyration&#44; cortical malformation&#44; dysgenesis of the corpus callosum&#44; and&#47;or cerebellar hypoplasia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2853217.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Ventriculomegaly was defined as axial diameter greater than 10&#160;mm across the atrium at the level of the posterior horns&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Modified Noyola scale&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">IUGR&#58; intrauterine growth retardation&#46;</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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hypoacusia&nbsp;\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">13 patients &#40;36&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IUGR&nbsp;\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">9 patients &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Microcephalus&nbsp;\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">5 patients &#40;13&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thrombocytopaenia&nbsp;\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">4 patients &#40;11&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Petechiae&nbsp;\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 patients &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatosplenomegaly&nbsp;\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 patients &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hepatitis&nbsp;\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">1 patient &#40;2&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hyperbilirubinaemia&nbsp;\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">1 patient &#40;2&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chorioretinitis&nbsp;\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">1 patient &#40;2&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2853218.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical symptoms at birth&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">MRI&#58; magnetic resonance imaging&#46;</p>"
          "tablatextoimagen" => array:3 [
            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"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transfontanellar ultrasound&#59; n&#160;&#61;&#160;30 &#40;normal&#44; n&#160;&#61;&#160;10&#59; alterations&#44; n&#160;&#61;&#160;20&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">White matter alterations&nbsp;\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">8 patients &#40;22&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lenticulostriate vasculopathy&nbsp;\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">8 patients &#40;22&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ventriculomegaly&nbsp;\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">6 patients &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Calcifications&nbsp;\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">5 patients &#40;13&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cortical atrophy&nbsp;\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">1 patient &#40;2&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2853219.png"
              ]
            ]
            1 => 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"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Brain MRI&#44; n&#160;&#61;&#160;29 &#40;normal&#44; n&#160;&#61;&#160;9&#59; alterations&#44; n&#160;&#61;&#160;20&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">White matter alterations&nbsp;\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">18 patients &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cysts&nbsp;\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">9 patients &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ventriculomegaly&nbsp;\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">7 patients &#40;19&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vasculopathy&nbsp;\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">6 patients &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cortical atrophy&nbsp;\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">4 patients &#40;11&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Calcifications&nbsp;\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 patients &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cerebellar atrophy&nbsp;\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">1 patient &#40;2&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2853216.png"
              ]
            ]
            2 => 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"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Neurological symptoms in patients with brain MRI alterations &#40;n&#160;&#61;&#160;20&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Delayed psychomotor development&nbsp;\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">13 patients &#40;65&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;007&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hearing loss&nbsp;\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">11 patients &#40;55&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;004&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cognitive alterations&nbsp;\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">10 patients &#40;50&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;009&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Speech impairment&nbsp;\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">10 patients &#40;50&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;046&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Seizures&nbsp;\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">1 patient &#40;5&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;495&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chorioretinitis&nbsp;\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">1 patient &#40;5&#37;&#41; &#40;<span class="elsevierStyleItalic">P</span>&#160;&#61;&#160;&#46;548&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2853220.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Neuroimaging findings&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:27 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Grupo de estudio de la infecci&#243;n cong&#233;nita por citomegalovirus de la Sociedad Espa&#241;ola de Infectolog&#237;a Pedi&#225;trica&#46; Consensus document from the Spanish Society of Paediatric Infectious Diseases &#40;SEIP&#41; on the diagnosis and treatment of congenital cytomegalovirus infection &#91;Article in Spanish&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46; Baquero-Artigao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
                        "fecha" => "2009"
                        "volumen" => "71"
                        "paginaInicial" => "535"
                        "paginaFinal" => "547"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Role of cerebral ultrasound and magnetic resonance imaging in newborns with congenital cytomegalovirus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;G&#46; Capretti"
                            1 => "M&#46; Lanari"
                            2 => "G&#46; Tani"
                            3 => "G&#46; Ancora"
                            4 => "R&#46; Sciutti"
                            5 => "C&#46; Marsico"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.braindev.2013.04.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Brain Dev"
                        "fecha" => "2014"
                        "volumen" => "36"
                        "paginaInicial" => "203"
                        "paginaFinal" => "211"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23647916"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlation between white matter lesions and intelligence quotient in patients with congenital cytomegalovirus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46; Inaba"
                            1 => "M&#46; Motobayashi"
                            2 => "M&#46; Nishioka"
                            3 => "T&#46; Kaneko"
                            4 => "S&#46; Yamauchi"
                            5 => "Y&#46; Kawasaki"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pediatrneurol.2015.11.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Neurol"
                        "fecha" => "2016"
                        "volumen" => "55"
                        "paginaInicial" => "52"
                        "paginaFinal" => "57"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26778145"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Symptomatic congenital cytomegalovirus infection&#58; neonatal morbidity and mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;B&#46; Boppana"
                            1 => "R&#46;F&#46; Pass"
                            2 => "W&#46;J&#46; Britt"
                            3 => "S&#46; Stagno"
                            4 => "C&#46;A&#46; Alford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00006454-199202000-00007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "1992"
                        "volumen" => "11"
                        "paginaInicial" => "93"
                        "paginaFinal" => "99"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1311066"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A wider role for congenital cytomegalovirus infection in sensorineural hearing loss"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Barbi"
                            1 => "S&#46; Binda"
                            2 => "S&#46; Caroppo"
                            3 => "U&#46; Ambrosetti"
                            4 => "C&#46; Corbetta"
                            5 => "P&#46; Sergi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00006454-200301000-00012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Infect Dis J"
                        "fecha" => "2003"
                        "volumen" => "22"
                        "paginaInicial" => "39"
                        "paginaFinal" => "42"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12544407"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Progressive hearing loss in infants with asymptomatic congenital cytomegalovirus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;D&#46; Williamson"
                            1 => "G&#46;J&#46; Demmler"
                            2 => "A&#46;K&#46; Percy"
                            3 => "F&#46;I&#46; Catlin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1992"
                        "volumen" => "90"
                        "paginaInicial" => "862"
                        "paginaFinal" => "866"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1331946"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Brain magnetic resonance findings in symptomatic congenital cytomegalovirus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Manara"
                            1 => "L&#46; Balao"
                            2 => "C&#46; Baracchini"
                            3 => "P&#46; Drigo"
                            4 => "R&#46; D&#8217;Elia"
                            5 => "E&#46;M&#46; Ruga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Radiol"
                        "fecha" => "2011"
                        "volumen" => "41"
                        "paginaInicial" => "962"
                        "paginaFinal" => "970"
                        "itemHostRev" => array:3 [
                          "pii" => "S1542356520306807"
                          "estado" => "S300"
                          "issn" => "15423565"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neuroradiographic findings in the newborn period and long-term outcome in children with symptomatic congenital cytomegalovirus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;B&#46; Boppana"
                            1 => "K&#46;B&#46; Fowler"
                            2 => "Y&#46; Vaid"
                            3 => "G&#46; Hedlund"
                            4 => "S&#46; Stagno"
                            5 => "W&#46;J&#46; Britt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1542/peds.99.3.409"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1997"
                        "volumen" => "99"
                        "paginaInicial" => "409"
                        "paginaFinal" => "414"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9041297"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;E&#46; Noyola"
                            1 => "G&#46;J&#46; Demmler"
                            2 => "C&#46;T&#46; Nelson"
                            3 => "C&#46; Griesser"
                            4 => "W&#46;D&#46; Williamson"
                            5 => "J&#46;T&#46; Atkins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2001"
                        "volumen" => "138"
                        "paginaInicial" => "325"
                        "paginaFinal" => "331"
                        "itemHostRev" => array:3 [
                          "pii" => "S0168827818320658"
                          "estado" => "S300"
                          "issn" => "01688278"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The spectrum of cranial ultrasound and magnetic resonance imaging abnormalities in congenital cytomegalovirus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46;S&#46; de Vries"
                            1 => "H&#46; Gunardi"
                            2 => "P&#46;G&#46; Barth"
                            3 => "L&#46;A&#46; Bok"
                            4 => "M&#46;A&#46; Verboon-Maciolek"
                            5 => "F&#46; Groenendaal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2004-815833"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neuropediatrics"
                        "fecha" => "2004"
                        "volumen" => "35"
                        "paginaInicial" => "113"
                        "paginaFinal" => "119"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15127310"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical&#44; biochemical&#44; and neuroimaging findings predict long-term neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Alarcon"
                            1 => "M&#46; Martinez-Biarge"
                            2 => "F&#46; Cabanas"
                            3 => "A&#46; Hernanz"
                            4 => "J&#46; Quero"
                            5 => "A&#46; Garcia-Alix"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpeds.2013.06.055"
                      "Revista" => array:4 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2013"
                        "volumen" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23958115"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neuro-imaging findings in infants with congenital cytomegalovirus infection&#58; relation to trimester of infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Oosterom"
                            1 => "J&#46; Nijman"
                            2 => "J&#46; Gunkel"
                            3 => "T&#46;F&#46; Wolfs"
                            4 => "F&#46; Groenendaal"
                            5 => "M&#46;A&#46; Verboon-Maciolek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Neonatology"
                        "fecha" => "2015"
                        "volumen" => "107"
                        "paginaInicial" => "289"
                        "paginaFinal" => "296"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Beta2-microglobulin concentrations in cerebrospinal fluid correlate with neuroimaging findings in newborns with symptomatic congenital cytomegalovirus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Alarcon"
                            1 => "A&#46; Garcia-Alix"
                            2 => "F&#46; Cabanas"
                            3 => "A&#46; Hernanz"
                            4 => "D&#46; Pascual-Salcedo"
                            5 => "A&#46; Martin-Ancel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Pediatr"
                        "fecha" => "2006"
                        "volumen" => "165"
                        "paginaInicial" => "636"
                        "paginaFinal" => "645"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A Prognostic neonatal neuroimaging scale for symptomatic congenital cytomegalovirus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Alarcon"
                            1 => "M&#46; Martinez-Biarge"
                            2 => "F&#46; Cabanas"
                            3 => "J&#46; Quero"
                            4 => "A&#46; Garcia-Alix"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000446690"
                      "Revista" => array:7 [
                        "tituloSerie" => "Neonatology"
                        "fecha" => "2016"
                        "volumen" => "110"
                        "paginaInicial" => "277"
                        "paginaFinal" => "285"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27344149"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508508016788"
                          "estado" => "S300"
                          "issn" => "00165085"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Fern&#225;ndez C&#44; Lorenzo H&#44; Vrotsou K&#44; Aresti U&#44; Rica I&#44; S&#225;nchez E&#46; Estudio de crecimiento de Bilbao&#46; Curvas y tablas de crecimiento &#40;estudio transversal&#41;&#46; In&#58; Fundaci&#243;n Faustino Orbegozo Eizaguirre&#46; &#91;Accessed 15 June 2016&#93;&#46; Available from&#58; <a target="_blank" href="https://www.fundacionorbegozo.com/wp-content/uploads/pdf/estudios2011.pdf">https&#58;&#47;&#47;www&#46;fundacionorbegozo&#46;com&#47;wp-content&#47;uploads&#47;pdf&#47;estudios 2011&#46;pdf</a>&#46;"
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Late intrauterine cytomegalovirus infection&#58; clinical and neuroimaging findings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46;I&#46; Steinlin"
                            1 => "D&#46; Nadal"
                            2 => "G&#46;F&#46; Eich"
                            3 => "E&#46; Martin"
                            4 => "E&#46;J&#46; Boltshauser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Neurol"
                        "fecha" => "1996"
                        "volumen" => "15"
                        "paginaInicial" => "249"
                        "paginaFinal" => "253"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malformations of cortical development in children with congenital cytomegalovirus infection &#8212; a study of nine children with proven congenital cytomegalovirus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "V&#46;M&#46; Bosnjak"
                            1 => "I&#46; Dakovic"
                            2 => "V&#46; Duranovic"
                            3 => "L&#46; Lujic"
                            4 => "G&#46; Krakar"
                            5 => "B&#46; Marn"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Coll Antropol"
                        "fecha" => "2011"
                        "volumen" => "35"
                        "numero" => "Suppl 1"
                        "paginaInicial" => "229"
                        "paginaFinal" => "234"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21648339"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infections of the nervous system pediatric neuroimaging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Barkovich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:5 [
                        "fecha" => "2005"
                        "paginaInicial" => "802"
                        "paginaFinal" => "806"
                        "editorial" => "Lippcott Williams &#38;Wilkins"
                        "editorialLocalizacion" => "Philadelphia"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thalamic changes in a preterm sample with periventricular leukomalacia&#58; correlation with white-matter integrity and cognitive outcome at school age"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Zubiaurre-Elorza"
                            1 => "S&#46; Soria-Pastor"
                            2 => "C&#46; Junque"
                            3 => "D&#46; Fernandez-Espejo"
                            4 => "D&#46; Segarra"
                            5 => "N&#46; Bargallo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/pr.2011.70"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatr Res"
                        "fecha" => "2012"
                        "volumen" => "71"
                        "paginaInicial" => "354"
                        "paginaFinal" => "360"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22391635"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0168827820301264"
                          "estado" => "S300"
                          "issn" => "01688278"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Brain magnetic resonance imaging findings of congenital cytomegalovirus infection as a prognostic factor for neurological outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Kwak"
                            1 => "M&#46;S&#46; Yum"
                            2 => "H&#46;R&#46; Yeh"
                            3 => "H&#46;J&#46; Kim"
                            4 => "T&#46;S&#46; Ko"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pediatrneurol.2018.03.008"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatr Neurol"
                        "fecha" => "2018"
                        "volumen" => "83"
                        "paginaInicial" => "14"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29681488"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0168827820302786"
                          "estado" => "S300"
                          "issn" => "01688278"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is lenticulostriated vasculopathy an unfavorable prognostic finding in infants with congenital cytomegalovirus infection&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Giannattasio"
                            1 => "P&#46; Di Costanzo"
                            2 => "P&#46; Milite"
                            3 => "D&#46; De Martino"
                            4 => "E&#46; Capone"
                            5 => "A&#46; Romano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcv.2017.04.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Virol"
                        "fecha" => "2017"
                        "volumen" => "91"
                        "paginaInicial" => "31"
                        "paginaFinal" => "35"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28412596"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lenticulostriated vasculopathy is a high-risk marker for hearing loss in congenital cytomegalovirus infections"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Bilavsky"
                            1 => "M&#46; Schwarz"
                            2 => "J&#46; Pardo"
                            3 => "J&#46; Attias"
                            4 => "I&#46; Levy"
                            5 => "Y&#46; Haimi-Cohen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Acta Paediatr"
                        "fecha" => "2015"
                        "volumen" => "104"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is lenticulostriated vasculopathy a sign of central nervous system insult in infants with congenital CMV infection&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Amir"
                            1 => "M&#46; Schwarz"
                            2 => "I&#46; Levy"
                            3 => "Y&#46; Haimi-Cohen"
                            4 => "J&#46; Pardo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/adc.2010.208405"
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "2011"
                        "volumen" => "96"
                        "paginaInicial" => "846"
                        "paginaFinal" => "850"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21715394"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1542356514014670"
                          "estado" => "S300"
                          "issn" => "15423565"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transport&#44; monitoring&#44; and successful brain MR imaging in unsedated neonates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;M&#46; Mathur"
                            1 => "J&#46;J&#46; Neil"
                            2 => "R&#46;C&#46; McKinstry"
                            3 => "T&#46;E&#46; Inder"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00247-007-0705-9"
                      "Revista" => array:7 [
                        "tituloSerie" => "Pediatr Radiol"
                        "fecha" => "2008"
                        "volumen" => "38"
                        "paginaInicial" => "260"
                        "paginaFinal" => "264"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18175110"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2468125320302521"
                          "estado" => "S300"
                          "issn" => "24681253"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Neurodevelopmental outcomes following ganciclovir therapy in symptomatic congenital cytomegalovirus infections involving the central nervous system"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;E&#46; Oliver"
                            1 => "G&#46;A&#46; Cloud"
                            2 => "P&#46;J&#46; Sanchez"
                            3 => "G&#46;J&#46; Demmler"
                            4 => "W&#46; Dankner"
                            5 => "M&#46; Shelton"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcv.2009.08.012"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Clin Virol"
                        "fecha" => "2009"
                        "volumen" => "46"
                        "numero" => "Suppl 4"
                        "paginaInicial" => "S22"
                        "paginaFinal" => "S26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19766534"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Brain magnetic resonance imaging findings of congenital cytomegalovirus infectionas a prognostic factor for neurological outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Kwak"
                            1 => "M&#46;&#46;S&#46; Yum"
                            2 => "H&#46;&#46;R&#46; Yeh"
                            3 => "H&#46;&#46;J&#46; Kim"
                            4 => "T&#46;&#46;S&#46; Ko"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pediatrneurol.2018.03.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Neurol"
                        "fecha" => "2018"
                        "volumen" => "83"
                        "paginaInicial" => "14"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29681488"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Maturation of white matter in the human brain&#58; a review of magnetic resonance studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46; Paus"
                            1 => "D&#46;L&#46; Collins"
                            2 => "A&#46;C&#46; Evans"
                            3 => "G&#46; Leonard"
                            4 => "B&#46; Pike"
                            5 => "A&#46; Zijdenbos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0361-9230(00)00434-2"
                      "Revista" => array:7 [
                        "tituloSerie" => "Brain Res Bull"
                        "fecha" => "2001"
                        "volumen" => "54"
                        "paginaInicial" => "255"
                        "paginaFinal" => "266"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11287130"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2468125317301425"
                          "estado" => "S300"
                          "issn" => "24681253"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735808/0000003700000002/v1_202203100608/S2173580821001401/v1_202203100608/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/21735808/0000003700000002/v1_202203100608/S2173580821001401/v1_202203100608/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173580821001401?idApp=UINPBA00004N"
]

Article information

ISSN: 21735808
Original language: English

DOI:10.1016/j.nrleng.2018.11.011

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	8	0	8
2024 October	61	10	71
2024 September	75	22	97
2024 August	60	26	86
2024 July	68	21	89
2024 June	56	13	69
2024 May	38	17	55
2024 April	52	17	69
2024 March	58	23	81
2024 February	92	28	120
2024 January	68	11	79
2023 December	89	36	125
2023 November	87	17	104
2023 October	85	17	102
2023 September	63	9	72
2023 August	53	16	69
2023 July	78	13	91
2023 June	62	10	72
2023 May	63	19	82
2023 April	47	19	66
2023 March	17	13	30
2023 February	23	12	35
2023 January	24	15	39
2022 December	31	15	46
2022 November	49	12	61
2022 October	51	14	65
2022 September	49	15	64
2022 August	40	10	50
2022 July	31	16	47
2022 June	34	14	48
2022 May	34	11	45
2022 April	54	9	63
2022 March	44	17	61
2022 February	32	7	39
2022 January	42	12	54
2021 December	38	10	48
2021 November	14	13	27
2021 October	22	11	33
2021 September	15	1	16

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter