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2010-08-09-12 Cytomegalovirus infection with lissencephaly in twin pregnancy © Cuillier www.TheFetus.net

Cytomegalovirus infection with lissencephaly
in twin pregnancy


Fabrice Cuillier
, MD.*, P. Fossati, MD.**

*   Department of Gynecology, Felix Guyon Hospital, 97400 Saint- Denis, Ile de la Reunion, France; tel: 0262 90 55 22; fax : 0262 90 77 30.
** Department of Radiology, Félix Guyon Hospital, 97400 Saint-Denis, Reunion’ Island, France. 
 

Case report

This is a case of a 28-year-old-woman, G2P1, with no known obstetrics risk factors and no relevant medical history. The first ultrasound showed diamniotic dichorionic twin pregnancy. The pregnancy was uncomplicated, patient was not aware of fever or any signs of infection, shortly before conception and in the first and second trimester of the pregnancy. The first trimester scan was normal, with NT=1 mm for both fetuses. Triple test was negative.

The second trimester scan performed at 22 weeks of gestation showed two female fetuses with normal growth. There were no abnormalities seen during the ultrasound examination.

The following ultrasound examination was done at 24 weeks of gestation with the following findings:

Twin A
 
Ultrasound scan revealed cerebral anomalies and these findings were confirmed by the follow-up ultrasound at 27 weeks:
  • Progressive bilateral ventriculomegaly
  • Periventricular echogenicity
  • Corpus callosum hypoplasia or agenesis
  • Lissencephaly
  • Calcifications

Images 1,2
: Image 1 shows the profile of the fetus. Image 2 shows an axial view of the fetal brain, note the borderline size of the cisterna magna (9.8 mm), increased subarachnoid space and ventriculomegaly.

 

Images 3,4: Image 3 shows the subarachnoid space. Image 4 shows periventricular echogenicity, suggestive of cytomegalovirus.



Images 5,6: Images showing periventricular echogenicity, calcifications, lissencephaly.



Images 7,8: Images showing calcifications.



Images 9,10: Bilateral ventriculomegaly, lateral ventricles measuring over 12 mm.



Image 11: MRI of the fetal brain, note increased subarachnoid space and lissencephaly.




Twin B

There were no abnormalities seen at 24 weeks, except of abnormal posterior fossa (13 mm). The scan at 27 weeks showed bilateral ventriculomegaly. Ultrasound at 30 weeks showed cyst in the cerebellum and periventricular calcifications. Calcifications were even more obvious on the scan at 33 weeks.

Images 1,2
: Image 1 shows enlarged cisterna magna. Image 2 shows dilated lateral ventricle.



Images 3,4: Images periventricular echogenicity.

 

Images 5,6
: Image 5 shows cyst within the cerebellum. Image 6 shows periventricular calcifications.



Images 7,8: Image 7 shows cisterna magna of both twins, twin A is on the right and twin B on the left. Image 8 shows periventricular echogenicity, twin A on the left and twin B on the right.



Images 9,10: MRI images, note lissencephaly, ventriculomegaly and increased subarachnoid space.


 

We performed an amniocentesis at 31 weeks. The fetal karyotype was normal 46 XX for both fetuses. We also tested the amniotic fluid for Herpes simplex virus, Cytomegalovirus and Parvovirus B19. MRI images confirmed the ultrasound findings in both fetuses, lissencepahly, bilateral ventriculomegaly and agenesis of the corpus callosum at twin A. Twin B showed lissencephaly with enlarged cisterna magna.

Patient decided for the pregnancy termination at 33 weeks based on the counseling with neonatologist, neurologist and psychiatrist. They explained the adverse prognosis for both twins, spasm, seizures, failure to thrive, deafness.

The final results showed a presence of cytolomegalovirus in the amniotic fluid.




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