Zika virus associated microcephaly/micrencephaly—fetal brain imaging in comparison with neuropathology

Abstract

virus associated microcephaly/micrencephaly-fetal brain imaging in comparison with neuropathology. BJOG 2017;124:521-525. In December 2015, during the Zika virus (ZIKV) epidemic in Brazil, a possible association between ZIKV infection during pregnancy and fetal brain malformations was suspected due to a 20-fold rise in cases of microcephaly among newborns. 1,2 Several reports published thereafter have strengthened the association between ZIKV and fetal brain damage. [3][4][5][6] Prenatal diagnosis of microcephaly and/or fetal brain damage caused by infectious agents is based on neuroimaging techniques, ultrasound and magnetic resonance imaging (MRI), which in combination display most pathological changes, such as microcephaly (small head), micrencephaly (small brain), ventriculomegaly, cortical maldevelopment, porencephalic cysts, cerebellar atrophy and calcifications. 7,8 In this case report we compare intrauterine fetal brain neuroimaging with post-mortem neuropathology in a confirmed case of microcephaly/micrencephaly associated with ZIKV, giving a possible explanation for some imaging findings that were not confirmed on autopsy.A 25-year-old European woman who lived in Natal, Bahia, Brazil developed signs of infection during the 13th week of gestation and ZIKV was highly suspected. Ultrasound at 14th and 20th weeks of gestation showed normal fetal growth and anatomy. 5 After returning to Europe in the late second trimester of her pregnancy, ultrasound showed fetal brain anomalies for the first time. She was referred to a tertiary referral hospital where ultrasound and MRI were performed in the 29th week of gestation, and ultrasound was repeated in the 31st and 32nd weeks of gestation.The ultrasound examinations revealed microcephaly, ventriculomegaly, enlarged cisterna magna, small cerebellum and scattered calcifications throughout the brain (Figure 1A, see Figure S1).On MRI ( Figure 1B-D), a severe reduction of the brain volume was observed, predominantly of the frontal and parieto-occipital lobes. The volume of the temporal lobes was relatively spared. Infratentorial structures were less severely affected although transverse cerebellar diameter and vermis height were smaller than expected for gestational age. The basal ganglia, thalami and brainstem were relatively spared. A large area of cystic encephalomalacia was demonstrated in the right parieto-occipital lobe, and smaller pseudocysts were visible in the left occipital lobe and in the frontal subcortical white matter. Confluent T2 hyperintensities of the supratentorial white matter with increased diffusion on diffusion-weighted imaging were noticed in the temporo-occipital lobes, corresponding to oedema. On T2 fast field echo (FFE) sequence, subtle hypointensity in the left caudothalamic groove was noted, probably corresponding to a small haemorrhage. Several small T2 hypointense foci in the periventricular and cortical-subcortical areas could correspond to grey matter displacement or calcifications ( Figure 1D), the latter being well depicted 521 ª ...

Congenital Zika syndrome: A systematic review

“…Parenchymal or cerebellar calcification were described in 37 studies of our review [19,23,40,45,59,[62][63][64][65][66][67][68][69][70][71][73][74][75][76][78][79][80][81][82][83][84][85]87,90,91,93,94,[96][97][98]100,101] and also in other review which reported a prevalence of 42.6% [47]. These findings may also be found in congenital infections known by the mnemonic TORCH (Toxoplasmosis, Rubella, Cytomegalovirus (CMV) and Herpes.…”

“…Microcephaly was the most frequent sign found in neonates exposed to ZIKV during pregnancy among the articles in our review [28,[38][39][40][41]. Forty one studies reported microcephaly [19,23,40,45,[58][59][60][62][63][64][65][66][67]69,70,70,71,[73][74][75][76][79][80][81][82][83][84][85][86][87][89][90][91][92][93][94][96][97][98][99][100][101]. Other studies, using different methodologies, have reported similar results [104][105]…”

Zika viral infection and neutralizing human antibody response in a BLT humanized mouse model

“…In recent ZIKV outbreaks, there was a higher risk/incidence of Guillain-Barre syndrome (GBS) in adults (do Rosário et al, 2016; Paploski et al, 2016) and severe birth defects including fetal microcephaly (now collectively termed as Congenital Zika Syndrome (CZS)), which are directly attributed to ZIKV infection of pregnant women (Calvet et al, 2016; Mlakar et al, 2016; Oliveira et al, 2016; Schuler-Faccini et al, 2016; Vesnaver et al, 2017). Aedes aegypti and Aedes albopictus are the major mosquito vectors for viral transmission (Aliota et al, 2017).…”

Maternal-Fetal Interplay in Zika Virus Infection and Adverse Perinatal Outcomes

“…Maternal ZIKV infection during pregnancy is usually asymptomatic for the mothers and can induce severe damage to the fetus similar to that found in the TORCH infections, such as fetal microcephaly, which was reported during the Brazilian epidemic in 2015 (111). Additional damage may include eye injuries, fetal growth restriction, and congenital contractures (112).…”