Common findings on head computed tomography in neonates with confirmed congenital Zika syndrome

Abstract

ObjectiveTo describe head computed tomography (CT) findings in neonates with congenital Zika virus infection confirmed in cerebrospinal fluid.Materials and MethodsThis was a study of 16 newborn infants who exhibited abnormal head CT findings during an outbreak of Zika virus infection. Those infants had the following features: brain imaging suggestive of congenital infection; brain calcifications and negative results on tests for other main infectious causes of primary microcephaly, namely toxoplasmosis, cytomegalovirus, rubella, and HIV; positivity for Zika virus on IgM antibody capture enzyme-linked immunosorbent assay in cerebrospinal fluid.ResultsDecreased brain volume was observed in 13 (81.2%) of the infants. All of the infants showed cortico-subcortical calcifications, mainly located in the frontal lobe. In 15 neonates (93.7%), ventriculomegaly was observed. Colpocephaly was a common finding, being observed in 10 patients (62.5%). A prominent occipital bone was identified in 9 patients (56.2%).ConclusionOur study proves that Zika virus infection can cause congenital brain damage, with or without microcephaly. Some predominant head CT findings in neonates with congenital Zika virus infection, although not pathognomonic, are strongly suggestive of a pattern.

Zika virus infection as a cause of congenital brain abnormalities and Guillain-Barré syndrome: A living systematic review

“…Traveller/non-traveller populations: In this update, we found further evidence that congenital abnormalities occurred in infants born to women travellers returning from ZIKV-affected areas and women remaining in those areas. In total, 25 publications report on 272 congenital abnormalities due to ZIKV infection in travellers 27, 29, 30, 32, 34, 36, 38, 42, 45, 56, 58, 61, 89, 94, 98, 109, 117, 122, 123, 137, 140, 151, 153, 166, 173 , with 109 publications reporting congenital abnormalities due to ZIKV in 2652 non travellers 24– 26, 28, 31, 33, 35, 37, 39– 41, 43, 44, 46– 48, 50, 51, 54, 57, 60, 62– 79, 81, 83– 85, 87, 88, 90– 93, 95– 97, 100, 101, 104– 106, 110– 113, 115, 116, 118, 119, 121, 124– 135, 142– 147, 149, 152, 154, 156– 164, 167, 168, 171, 172, 175– 180, 182, …”

Congenital Zika Virus Infection: a Review with Emphasis on the Spectrum of Brain Abnormalities

“…The main findings in brain computed tomography (CT) are calcifications (predominantly at the cortico-subcortical junction, in the frontal lobes), malformation of cortical development, cerebral volume reduction, and ventriculomegaly and prominence of the occipital bone [47].…”

“…Brain calcifications described in CZS can also be punctate and coarse (Fig. 1a, b ) [ 47 ]. In some cases, a layered calcification appearance can be seen in cortical gray and white matter [ 48 •].…”

Zika virus infection

“…Fetal changes resulting from intrauterine ZIKV infection are more severe when they occur in the first or second trimesters of pregnancy, such changes ranging from fetal death to various congenital anomalies such as redundant neck skin with occipital bone proeminence, low birth weight, anasarca, X arthrogryposis, hearing loss, polyhydramnios, ocular malformations, and CNS anomalies (3,12) . The fetal abnormalities most commonly visualized by ultrasound and magnetic resonance imaging (MRI) are microcephaly, ventriculomegaly, and multifocal calcifications, less common abnormalities including posterior fossa alterations, such as cerebellar and pontine hypoplasia (3,11) .…”

“…In the postnatal period, the main lesions are visualized by ultrasound, computed tomography (CT), or MRI. Perinatal MRI and CT allow the diagnosis of pachygyria, dysgenesis of the corpus callosum, cortical atrophy, and a small anterior fontanelle with premature closure of the cranial sutures (12)(13)(14)(15)(16) .…”