Zika virus (ZIKV) is an arthropod-borne flavivirus transmitted through bites of the Aedes mosquitoes. Infected mothers can vertically transmit ZIKV to their fetuses, particularly during the first and second trimesters. Infections beginning during early gestation can cause congenital Zika virus syndrome (CZS), which may be marked by arrested development and/or altered healing in the nervous system. There can be microcephaly, craniosynostosis, intracranial calcifications, ventriculomegaly, low brain volume and/or cortical atrophy, and hypoplasia/altered myelination in the corpus callosum, cerebellum, and brainstem. There may also be altered development with polymicrogyria, pachygyria, and lissencephaly. Clinically, infants with CZS may show facial dysmorphism, pulmonary hypoplasia, altered growth and development, hypertonia, hyperreflexia, limb contractures, and arthrogryposis multiplex. Perinatal infections can present with irritability, seizures, eye involvement, and sensorineural hearing loss (SNHL). Congenital zika virus syn and perinatal infections contrast with those acquired after birth, which usually have a relatively milder course. Overall, the mortality rate can reach 4-6%. Laboratory evaluation can include polymerase chain reactions on serum, cerebrospinal fluid, and urine; testing for immunoglobulin M (IgM); and plaque reduction neutralization tests (PRNTs) to confirm the specificity of these Zika virus IgM (ZIKV IgM) antibodies. Unfortunately, no specific treatment is available; most measures are largely supportive.