Neuroimaging findings of congenital Zika virus infection: a pictorial essay

Abstract

Zika virus (ZIKV) is a mosquito-borne arbovirus from the Flaviviridae family. It had caused several epidemics since its discovery in 1947, but there was no significant attention to this virus until the recent outbreak in Brazil in 2015. The main concern is the causal relationship between prenatal ZIKV infection and congenital microcephaly, which has been confirmed recently. Moreover, ZIKV may cause other central nervous system abnormalities such as brain parenchymal atrophy with secondary ventriculomegaly, intracranial calcification, malformations of cortical development (such as polymicrogyria, and lissencephaly-pachygyria), agenesis/hypoplasia of the corpus callosum, cerebellar and brainstem hypoplasia, sensorineural hearing-loss, and ocular abnormalities as well as arthrogryposis in the infected fetuses. Postnatal (acquired) ZIKV infection usually has an asymptomatic or mildly symptomatic course, while prenatal (congenital) ZIKV infection has a more severe course and may cause severe brain anomalies that are described as congenital Zika syndrome. In this pictorial essay, we aim to illustrate the prenatal and postnatal neuroimaging findings that may be seen in fetuses and neonates with congenital Zika syndrome, and will discuss possible radiological differential diagnoses. A detailed knowledge of these findings is paramount for an early correct diagnosis, prognosis determination, and counseling of the affected children and families.

Postnatal Zika virus infection is associated with persistent abnormalities in brain structure, function, and behavior in infant macaques

“…ZIKV has been linked with damage to the visual system, with ocular and brain visual system abnormalities seen in congenital ZIKV infection (50, 77, 78). Additionally, adults with Guillain-Barre Syndrome following ZIKV infection exhibit cytotoxic edema in the occipital lobe (79), the location of the visual cortex.…”

Zika Virus Linked Microcephaly and other Neurological Anomalies Epidemic on Neonatal-Perinatal Medicine: Perspective

“…The evidence-based causal relationship between Zika virus and microcephaly and other brain anomalies public health and economic impact calls for an urgent need to establish contextual and effective local and global neonatal-perinatal and postnatal longitudinal surveillance-response system policies and interventions implementation [1][2][3][11][12][13][14][15][16]. Enhancing robust laboratory data and information and analysis findings to appropriately define Zika viral infection syndrome pre, during and post pregnancy.…”

“…In addition, elucidating Aedes and sexual transmission related Zika virus transmission ecological, adaptation and human health threat and complications requires coordinated approach to data sharing, surveillance and research is needed in defining the full spectrum of congenital Zika virus syndrome and issues on maternal-child health [11][12][13]. Innovative approaches in Zika vaccines and therapeutic targets discovery and development should be explored coupled with in silico phylogenetics and phylogeography modelling in understanding its evidence about Zika virus infection congenital abnormalities public health threats [14,15].…”

Is Zika Virus an Emerging TORCH Agent? An Invited Commentary

“…Accordingly, FBDS is defined as partial fetal brain destruction due to a disruptive agent leading to a reduction in the intracranial hydrostatic pressure, which results in the subsequent collapse of the fetal skull. Fetal brain disruption sequence is clinically characterized by severe microcephaly, overlapping skull sutures, prominence of the occipital bone, and scalp rugae 6,13–17

Prenatal ZIKV infection causes severe congenital anomalies, mostly in the central nervous system (CNS).

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“…It should be emphasized that although microcephaly is the most common finding in CZS; there are a few reports of CZS cases with severe brain anomalies but normal head circumference at birth. Therefore, it seems that ZIKV can cause a wide spectrum of abnormalities in the fetal CNS 1,17,18…”