Congenital Zika syndrome and neuroimaging findings: what do we know so far?

Although infection with the Zika virus was first recognized in 1942, it received little attention until 2007, when a true pandemic spread throughout Africa, Asia, and the Americas. Since then, numerous forms of central nervous system involvement have been described, mainly malformations related to congenital infection. Although the neuroimaging findings in congenital Zika syndrome are not pathognomonic, many are quite suggestive of the diagnosis, and radiologists should be prepared to interpret such findings accordingly. The objective of this article is to review the computed tomography and magnetic resonance imaging findings in congenital Zika syndrome.

Keywords:
Magnetic resonance imaging; Computed tomography; Zika virus; Congenital Zika syndrome; Congenital infection

Authorship

Bruno Niemeyer de Freitas Ribeiro Mailing address: Dr. Bruno Niemeyer de Freitas Ribeiro. Instituto Estadual do Cérebro Paulo Niemeyer – Departamento de Radiologia. Rua do Rezende, 156, Centro. Rio de Janeiro, RJ, Brazil, 22231-092. E-mail: bruno.niemeyer@hotmail.com.

Masters Student, MD, Neuroradiologist at the Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.Instituto Estadual do Cérebro Paulo NiemeyerBrazilRio de Janeiro, RJ, BrazilMasters Student, MD, Neuroradiologist at the Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.

Bernardo Carvalho Muniz

Full Member of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Neuroradiologist at the Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.Instituto Estadual do Cérebro Paulo NiemeyerBrazilRio de Janeiro, RJ, BrazilFull Member of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Neuroradiologist at the Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.

Emerson Leandro Gasparetto

PhD, MD, Neuroradiologist, Head of the Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.Instituto Estadual do Cérebro Paulo NiemeyerBrazilRio de Janeiro, RJ, BrazilPhD, MD, Neuroradiologist, Head of the Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.

Nina Ventura

PhD, MD, Neuroradiologist at the Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.Instituto Estadual do Cérebro Paulo NiemeyerBrazilRio de Janeiro, RJ, BrazilPhD, MD, Neuroradiologist at the Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.

Edson Marchiori

Full Professor at the Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilFull Professor at the Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

Mailing address: Dr. Bruno Niemeyer de Freitas Ribeiro. Instituto Estadual do Cérebro Paulo Niemeyer – Departamento de Radiologia. Rua do Rezende, 156, Centro. Rio de Janeiro, RJ, Brazil, 22231-092. E-mail: bruno.niemeyer@hotmail.com.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (9)

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Figure 1
A 3-month-old patient. Sagittal T1-weighted MRI slice, without contrast, showing craniofacial disproportion with a microcephalic aspect, together with occipital prominence and cutis verticis gyrata (arrowheads). Note also the confluence of the enlarged dural venous sinuses and the heterogeneous material (arrow).

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Figure 2
A 2-month-old patient. Axial T2-weighted MRI slice showing marked simplification of the gyral pattern, with agyria (arrows). Note also the diffuse increase in the extra-axial CSF space (asterisks).

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Figure 3
A: A 2-month-old patient. Axial T1-weighted MRI slice, without contrast, showing multiple punctate foci of hyperintensity at the cortical-subcortical junction of the frontal and parietal lobes, indicative of calcifications (arrows). Note also the cutis verticis gyrata (arrowheads). B: A 6-month-old patient. Axial susceptibility-weighted MRI sequence showing foci of hypointensity at the cortical-subcortical junction, affecting both hemispheres of the brain and more conspicuous in the frontal regions, because of the presence of calcifications (arrows).

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Figure 4
A: A 5-month-old patient. Axial CT scan, without contrast, showing foci of calcification in the basal nuclei (arrows) and left thalamus (arrowhead). B: A 5-month-old patient. Axial CT scan, without contrast, showing calcifications in the dorsolateral regions of the mesencephalic tegmentum (arrows), as well as at the cortical-subcortical junction in the temporal lobes (arrowheads).

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Figure 5
A: A 7-month-old patient. Magnetic resonance imaging, T2, axial section showing diffuse enlargement of the lateral ventricles (asterisks) and simplification of the gyral pattern (arrowheads). B: An 8-month-old patient. Axial T2-weighted MRI slice showing asymmetric dilation of the posterior portions of the lateral ventricles (asterisks), constituting a colpocephaly configuration.

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Figure 6
A 3-month-old patient. Sagittal T1-weighted MRI slice, without contrast, showing diffuse tapering of the corpus callosum (arrows). Note also the craniofacial disproportion with a microcephalic aspect.

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Figure 7
A 2-month-old patient. Sagittal T1-weighted MRI slice, without contrast, showing hypoplasia of the pons (arrow), with loss of the usual convexity. Also shown are an enlarged cisterna magna (asterisk), reduced cerebellar volume, and excessive skin in the nuchal region (arrowheads).

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Figure 8
A 2-month-old patient. Axial T2-weighted MRI slice showing diffuse, symmetric cerebellar hypoplasia (arrows), with prominence of the CSF spaces in the posterior fossa.

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Figure 9
A 14-month-old patient. Sagittal T1-weighted MRI slice showing tapering of the dorsal medulla (arrows) in a congenital Zika syndrome patient without arthrogryposis. Also shown are pontine hypoplasia (arrowhead) and an enlarged cisterna magna (asterisk).

Figure 1 A 3-month-old patient. Sagittal T1-weighted MRI slice, without contrast, showing craniofacial disproportion with a microcephalic aspect, together with occipital prominence and cutis verticis gyrata (arrowheads). Note also the confluence of the enlarged dural venous sinuses and the heterogeneous material (arrow).

Figure 2 A 2-month-old patient. Axial T2-weighted MRI slice showing marked simplification of the gyral pattern, with agyria (arrows). Note also the diffuse increase in the extra-axial CSF space (asterisks).

Figure 3 A: A 2-month-old patient. Axial T1-weighted MRI slice, without contrast, showing multiple punctate foci of hyperintensity at the cortical-subcortical junction of the frontal and parietal lobes, indicative of calcifications (arrows). Note also the cutis verticis gyrata (arrowheads). B: A 6-month-old patient. Axial susceptibility-weighted MRI sequence showing foci of hypointensity at the cortical-subcortical junction, affecting both hemispheres of the brain and more conspicuous in the frontal regions, because of the presence of calcifications (arrows).

Figure 4 A: A 5-month-old patient. Axial CT scan, without contrast, showing foci of calcification in the basal nuclei (arrows) and left thalamus (arrowhead). B: A 5-month-old patient. Axial CT scan, without contrast, showing calcifications in the dorsolateral regions of the mesencephalic tegmentum (arrows), as well as at the cortical-subcortical junction in the temporal lobes (arrowheads).

Figure 5 A: A 7-month-old patient. Magnetic resonance imaging, T2, axial section showing diffuse enlargement of the lateral ventricles (asterisks) and simplification of the gyral pattern (arrowheads). B: An 8-month-old patient. Axial T2-weighted MRI slice showing asymmetric dilation of the posterior portions of the lateral ventricles (asterisks), constituting a colpocephaly configuration.

Figure 6 A 3-month-old patient. Sagittal T1-weighted MRI slice, without contrast, showing diffuse tapering of the corpus callosum (arrows). Note also the craniofacial disproportion with a microcephalic aspect.

Figure 7 A 2-month-old patient. Sagittal T1-weighted MRI slice, without contrast, showing hypoplasia of the pons (arrow), with loss of the usual convexity. Also shown are an enlarged cisterna magna (asterisk), reduced cerebellar volume, and excessive skin in the nuchal region (arrowheads).

Figure 8 A 2-month-old patient. Axial T2-weighted MRI slice showing diffuse, symmetric cerebellar hypoplasia (arrows), with prominence of the CSF spaces in the posterior fossa.

Figure 9 A 14-month-old patient. Sagittal T1-weighted MRI slice showing tapering of the dorsal medulla (arrows) in a congenital Zika syndrome patient without arthrogryposis. Also shown are pontine hypoplasia (arrowhead) and an enlarged cisterna magna (asterisk).

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