Clinical, Neuroimaging, and Neurophysiological Findings in Children with Microcephaly Related to Congenital Zika Virus Infection

Abstract

Zika virus (ZIKV) infection appeared in Brazil in 2015, causing an epidemic outbreak with increased rates of microcephaly and other serious birth disorders. We reviewed 102 cases of children who were diagnosed with microcephaly at birth and who had gestational exposure to ZIKV during the outbreak. We describe the clinical, neuroimaging, and neurophysiological findings. Most mothers (81%) reported symptoms of ZIKV infection, especially cutaneous rash, during the first trimester of pregnancy. The microcephaly was severe in 54.9% of the cases. All infants presented with brain malformations. The most frequent neuroimaging findings were cerebral atrophy (92.1%), ventriculomegaly (92.1%), malformation of cortical development (85.1%), and cortical⁻subcortical calcifications (80.2%). Abnormalities in neurological exams were found in 97.0% of the cases, epileptogenic activity in 56.3%, and arthrogryposis in 10.8% of the infants. The sensorineural screening suggested hearing loss in 17.3% and visual impairment in 14.1% of the infants. This group of infants who presented with microcephaly and whose mothers were exposed to ZIKV early during pregnancy showed clinical and radiological criteria for congenital ZIKV infection. A high frequency of brain abnormalities and signs of early neurological disorders were found, and epileptogenic activity and signs of sensorineural alterations were common. This suggests that microcephaly can be associated with a worst spectrum of neurological manifestations.

Keywords: Zika virus; microcephaly; neuroimaging; neurologic examination.

Figure 1

Neuroimage findings in infants with Congenital Zika Syndrome (CZS). 3D CT image of a 3-month-old infant with probable CZS evidencing microcephaly and prominent occiput (A). Axial T2/FSE (Fast Spin Echo) MR image of a 4-month-old infant with possible CZS demonstrating ventriculomegaly, diffuse cerebral atrophy, and malformations of cortical development with a simplified gyral pattern (B). Axial CT image without contrast of a 4-month-old infant with possible CZS evidencing microcephaly, ventriculomegaly, and bilateral cortical and subcortical calcifications (C).