A newborn at 36 weeks gestation has petechiae, hepatosplenomegaly, chorioretinitis, and intracranial calcifications distributed diffusely throughout the brain parenchyma. TORCH serology reveals elevated IgM antibodies against CMV. Which finding BEST distinguishes congenital CMV from congenital toxoplasmosis on neuroimaging?

• A Basal ganglia calcifications favor CMV; periventricular calcifications favor toxoplasmosis
• B Periventricular calcifications favor CMV; scattered/basal ganglia calcifications favor toxoplasmosis ✓
• C Cerebral cortical atrophy is specific to toxoplasmosis
• D Hydrocephalus is pathognomonic of CMV and absent in toxoplasmosis

Explanation

The neuroimaging pattern of calcifications is the key distinguishing feature: congenital CMV produces periventricular calcifications (due to predilection of CMV for periventricular germinal matrix zone), while congenital toxoplasmosis produces diffuse scattered calcifications often involving the basal ganglia and cortex. Hydrocephalus is more characteristic of toxoplasmosis (due to aqueductal inflammation/obstruction), not CMV. Cortical atrophy can occur in both. This distinction is high-yield for NEET PG.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.