title: Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study.
abstract: OBJECTIVE
  To report radiological findings observed in computed tomography (CT) and magnetic resonance imaging (MRI) scans of the first cases of congenital infection and microcephaly presumably associated with the Zika virus in the current Brazilian epidemic.
  
  
  METHODS
  Retrospective study with a case series.
  
  
  METHODS
  Association for Assistance of Disabled Children (AACD), Pernambuco state, Brazil.
  
  
  METHODS
  23 children with a diagnosis of congenital infection presumably associated with the Zika virus during the Brazilian microcephaly epidemic.
  
  
  METHODS
  Types of abnormalities and the radiological pattern of lesions identified on CT and MRI brain scans.
  
  
  RESULTS
  Six of the 23 children tested positive for IgM antibodies to Zika virus in cerebrospinal fluid. The other 17 children met the protocol criteria for congenital infection presumably associated with the Zika virus, even without being tested for IgM antibodies to the virus--the test was not yet available on a routine basis. Of the 23 children, 15 underwent CT, seven underwent both CT and MRI, and one underwent MRI. Of the 22 children who underwent CT, all had calcifications in the junction between cortical and subcortical white matter, 21 (95%) had malformations of cortical development, 20 (91%) had a decreased brain volume, 19 (86%) had ventriculomegaly, and 11 (50%) had hypoplasia of the cerebellum or brainstem. Of the eight children who underwent MRI, all had calcifications in the junction between cortical and subcortical white matter, malformations of cortical development occurring predominantly in the frontal lobes, and ventriculomegaly. Seven of the eight (88%) children had enlarged cisterna magna, seven (88%) delayed myelination, and six each (75%) a moderate to severe decrease in brain volume, simplified gyral pattern, and abnormalities of the corpus callosum (38% hypogenesis and 38% hypoplasia). Malformations were symmetrical in 75% of the cases.
  
  
  CONCLUSIONS
  Severe cerebral damage was found on imaging in most of the children in this case series with congenital infection presumably associated with the Zika virus. The features most commonly found were brain calcifications in the junction between cortical and subcortical white matter associated with malformations of cortical development, often with a simplified gyral pattern and predominance of pachygyria or polymicrogyria in the frontal lobes. Additional findings were enlarged cisterna magna, abnormalities of corpus callosum (hypoplasia or hypogenesis), ventriculomegaly, delayed myelination, and hypoplasia of the cerebellum and the brainstem.
authors.affiliation: Centro Diagnostico Multimagem, Rua Frei Matias Tevis, 194, Ilha do Leite Recife Pernambuco 52010-450, Brazil; Medical School, Mauricio de Nassau University, Recife, Pernambuco, Brazil fatima.vascoaragao@gmail.com.
authors.forename: Maria
authors.initials: M
authors.lastname: de Fatima Vasco Aragao
authors.affiliation: Association for Assistance of Disabled Children, Recife, Brazil; Barão de Lucena Hospital, Recife, Brazil.
authors.forename: Vanessa
authors.initials: V
authors.lastname: van der Linden
authors.affiliation: PROCAPE, University of Pernambuco, Recife, Brazil.
authors.forename: Alessandra Mertens
authors.initials: AM
authors.lastname: Brainer-Lima
authors.affiliation: Oswaldo Cruz University Hospital, Recife, Brazil.
authors.forename: Regina Ramos
authors.initials: RR
authors.lastname: Coeli
authors.affiliation: Oswaldo Cruz University Hospital, Recife, Brazil.
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Rocha
authors.affiliation: Oswaldo Cruz University Hospital, Recife, Brazil.
authors.forename: Paula
authors.initials: P
authors.lastname: Sobral da Silva
authors.affiliation: Oswaldo Cruz University Hospital, Recife, Brazil.
authors.forename: Maria
authors.initials: M
authors.lastname: Durce Costa Gomes de Carvalho
authors.affiliation: Prof Fernando Figueira Integral Medicine Institute, Recife, Brazil.
authors.forename: Ana
authors.initials: A
authors.lastname: van der Linden
authors.affiliation: Medical School, Federal University of Pernambuco, Recife, Brazil.
authors.forename: Arthur
authors.initials: A
authors.lastname: Cesario de Holanda
authors.affiliation: Neurology and Neurosurgery, Federal University of Pernambuco, Recife, Brazil.
authors.forename: Marcelo Moraes
authors.initials: MM
authors.lastname: Valenca
mesh_terms: D000328:Adult; D061085:Agenesis of Corpus Callosum / Q000150:complications / Q000175:diagnosis*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D001938:Brazil; D002114:Calcinosis / Q000150:complications / Q000175:diagnosis*; D002946:Cisterna Magna / Q000000981:diagnostic imaging / Q000473:pathology; D003337:Corpus Callosum / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000175:diagnosis*; D007075:Immunoglobulin M / Q000134:cerebrospinal fluid; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D054220:Malformations of Cortical Development / Q000150:complications / Q000175:diagnosis*; D008831:Microcephaly / Q000150:complications / Q000175:diagnosis*; D009413:Nerve Fibers, Myelinated / Q000000981:diagnostic imaging / Q000473:pathology; D009929:Organ Size; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology; D055815:Young Adult; D000071244:Zika Virus / Q000276:immunology; D000071243:Zika Virus Infection / Q000150:complications / Q000151:congenital / Q000175:diagnosis*
chemical_list: D007075:Immunoglobulin M