Viral Infections of the Central Nervous System in Newborn Infants with Seizures Kirsi Mustonen Helsinki 2003 Viral Infections of the Central Nervous System in Newborn Infants with Seizures

Antibodies to varicella zoster virus in the cerebrospinal fluid of neonates with seizures. Archzoster virus infection after maternal subclinical infection: Clinical and neuropathological findings. ABBREVIATIONS BBB blood brain barrier BBBP blood brain barrier permeability CBF cerebral blood flow CMV cytomegalovirus CNS central nervous system CSF cerebrospinal fluid CP cerebral palsy CT computed tomography EBV Epstein-Barr virus EEG electroencephalogram EIA enzyme immunoassay EIU enzyme immunoassay unit GA gestational age HIV human immunodeficiency virus GFAP glial fibrillary acidic protein HIV human immunodeficiency virus H-MRS single voxel magnetic spectroscopy HSV herpes simplex virus IEA immediate early antigen IF immunofluorescence IgG index [(CSF IgG/serum IgG) x (serum albumin/CSF albumin)] LCM lymphocytic choriomeningitis mCBF mean hemispheric cerebral blood flow MRI magnetic resonance imaging NICU neonatal intensive care unit OD optic density PCR polymerase chain reaction PET positron emission tomography RBC red blood cell rCBF regional cerebral blood flow ROI region of interest RSV respiratory syncytial virus SEM standard error of mean SD standard deviation SPECT single photon emission computed tomography TORCH toxoplasma gondii, rubella-, cytomegalo-, herpes simplex virus US ultrasound VZV varicella-zoster virus WBC white blood cell 6 SUMMARY Viral infections of the central nervous system (CNS) in neonates may run unidentified. This was the rationale of our study. 1) Varicella-zoster virus (VZV) serological screening of cerebrospinal fluid (CSF) to 201 neonates with neurological problems was done. 2) Fifty neonates with seizures without obvious aetiology from a birth cohort of 5709 were studied for viral findings. 3) Findings of single photon emission computed tomography (SPECT) in 10 neonates with viral neurological infections were studied. Four neonates of the 201 neonates with neurological problems had antibodies to VZV in the CSF. Seizures and abnormal muscular tone were found, but no characteristic picture of congenital VZV infection. None of the mothers had had VZV infection during pregnancy, but in three a significant rise occurred in the antibody level in serum. One child died at the age of 4 months. Neuropathological examination showed foci of astrocytic hyperplasia but no specific signs. CNS viral infection was identified in 13 of the 50 neonates with seizures without obvious aetiology. Findings to VZV, herpes simplex 1 (HSV-1), HSV-2, cytomegalovirus, influenza A or B, parainfluenza 1, adeno or enteroviruses were detected in 12 neonates and pleocytosis without specific viral findings in one neonate. Mononuclear white blood cell count in the CSF was <20 x 10 6 /l at term, and later it …