ABSTRACT

Cytomegalovirus (CMV) is a ubiquitous virus with a worldwide distribution. Seroprevalence rates can approach 90% in certain populations. It is the largest virus in the herpes virus family and among the largest of all viruses. The virus results in cytomegalic cells in infected tissues, hence its name. CMV is one of the pathogens that can be transmitted in pregnancy and result in devastating brain injury in the developing fetus. Neurological disease can be seen in both immunocompetent and immunocompromised individuals. In the former group, meningoencephalitis and polyradiculitis are most common neurological complications, but these occur generally in the setting of a mononucleosis-like illness. In severely immunocompromised individuals, especially, in the setting of advanced AIDS, CMV-related neurological disorders are not uncommon. The neurological manifestations include retinitis, meningoencephalitis, myelitis, polyradiculopathy, mononeuritis multiplex, and peripheral neuropathy. The method of choice in establishing the diagnosis of CMV-related neurological disease is cerebrospinal fluid polymerase chain reaction for CMV DNA. However, other diagnostic measures including culturing the virus in human fibroblast cultures, examining affected tissues for the classic intranuclear “owl’s eyes” histochemical studies, and serological studies may be helpful. A variety of antiviral therapies are available to suppress disease activity including ganciclovir, foscarnet, and cidofovir.