From the Guidelines
Periventricular calcifications are primarily caused by congenital infections, particularly Cytomegalovirus (CMV), which is the most common cause, as evidenced by a study published in Nature Reviews Neurology in 2020 1. The most common causes of periventricular calcifications include:
- Congenital infections, such as CMV, toxoplasmosis, rubella, and herpes simplex virus
- Genetic disorders, such as tuberous sclerosis complex and Sturge-Weber syndrome
- Metabolic disorders, such as Cockayne syndrome
- Hypoxic-ischemic injury, particularly in premature infants These conditions can lead to calcifications in the periventricular region due to damage to the white matter surrounding the ventricles. According to a study published in Nature Reviews Neurology in 2020, CMV is a common cause of polymicrogyria, a condition characterized by abnormal brain development, and is associated with intracranial calcifications and white matter abnormalities 2. It is essential to note that periventricular calcifications can be visualized using neuroimaging techniques such as CT scans or MRI, which can help diagnose and manage the underlying cause of these brain abnormalities. A study published in Brain in 2019 highlights the importance of accurate diagnosis and differentiation of periventricular lesions from other conditions, such as multiple sclerosis and ischemic small-vessel disease 3. In clinical practice, it is crucial to consider the potential causes of periventricular calcifications and to prioritize diagnostic work-up and management strategies that address the underlying cause and minimize morbidity, mortality, and impact on quality of life. Key considerations in the diagnostic work-up include:
- Neuroimaging studies, such as CT scans or MRI
- Laboratory tests to detect congenital infections, such as CMV and toxoplasmosis
- Genetic testing to identify underlying genetic disorders
- Clinical evaluation to assess for signs and symptoms of metabolic disorders and hypoxic-ischemic injury.
From the Research
Causes of Periventricular Calcifications
- Periventricular calcifications can be caused by congenital infections, including cytomegalovirus (CMV) 4, 5 and toxoplasmosis 4, 6
- CMV infection is a common cause of periventricular calcifications, and can also be associated with microcephaly, ventriculomegaly, and brain atrophy 4, 5
- Toxoplasmosis can cause randomly distributed brain calcifications, ventricular dilatation, and white matter signal change 4, 6
- Other causes of periventricular calcifications include Zika virus infection 4, which can also cause microcephaly, ventriculomegaly, and brain atrophy
- Vascular-related causes, such as cavernous malformations, arteriovenous malformations, and chronic venous hypertension, can also lead to periventricular calcifications 7
- Endocrine/metabolic diseases, such as parathyroid and thyroid dysfunction, and inborn errors of metabolism, can also cause periventricular calcifications 7
- Neoplastic causes, such as pediatric brain tumors, can also lead to periventricular calcifications 7