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Neonatal brain ultrasound in congenital ZIKV infection. Dilatation of the lateral ventricles as well as calcifications in the basal ganglia and at the corticomedullary junction are noted on coronal (a), and sagittal (b) sections in a 23-day-old infant
Source publication
Zika virus (ZIKV) is a mosquito-borne arbovirus from the Flaviviridae family. It had caused several epidemics since its discovery in 1947, but there was no significant attention to this virus until the recent outbreak in Brazil in 2015. The main concern is the causal relationship between prenatal ZIKV infection and congenital microcephaly, which ha...
Citations
... It is crucial to identify the critical stage of pregnancy when Zika virus begins to exert neurotropic effects on the fetus in order to minimize the impact of the disease [26]. Some indirect findings suggest that the germinal matrix is the primary target of the Zika virus, which partially explains the imaging findings in children infected with the virus [27]. ...
... Neural progenitor cells are the primary target of Zika virus, explaining the extensive CNS changes found in neuroimaging studies [27]. The programmed destruction of germinal matrix cells, considering the virus' neurotropism and the abundance of these cells in the fetal and neonatal brain, is one of the possible explanations for microcephaly, which is one of the most prominent findings in this disease [27]. ...
... Neural progenitor cells are the primary target of Zika virus, explaining the extensive CNS changes found in neuroimaging studies [27]. The programmed destruction of germinal matrix cells, considering the virus' neurotropism and the abundance of these cells in the fetal and neonatal brain, is one of the possible explanations for microcephaly, which is one of the most prominent findings in this disease [27]. ...
Viral infections in low-income countries such as Brazil pose a significant challenge for medical authorities, with epidemics such as Zika virus infection having lasting effects. The increase in microcephaly among newborns has prompted investigations into the association between Zika virus and this congenital syndrome. The severity and prevalence of microcephaly led to the declaration of national and international emergencies. Extensive research has been conducted to understand the teratogenic effects of Zika virus, particularly its impact on neural progenitor cells in the fetal brain. Various pre- and postnatal imaging techniques, such as ultrasound, magnetic resonance imaging (MRI), and postnatal computed tomography (CT), have played crucial roles in diagnosing and monitoring malformations linked to congenital Zika virus infection in the central nervous system (CNS). These modalities can detect brain parenchymal abnormalities, calcifications, cerebral atrophy, and callosal anomalies. Additionally, three-dimensional ultrasound and fetal MRI provide detailed anatomical images, while CT can identify calcifications that are not easily detected by other methods. Despite advancements in imaging, there are still unanswered questions and ongoing challenges in comprehending the long-term effects and developmental impairments in children affected by Zika virus. Radiologists continue to play a crucial role in diagnosing and assisting in the management of these cases.
Graphical Abstract
... ocasionando um córtex diminuído e. inclusive. hipoplasia ao nível do tronco encefálico13 . Um estudo concluiu que o comprometimento auditivo na microcefalia é um neurodéficit comum que pode ser autenticamente avaliado pelo PEATE e que o comprometimento auditivo em microcefálicos é principalmente devido à insuficiência dos componentes centrais da via auditiva ao nível do tronco encefálico ...
Purpose
to analyze the absolute latencies of waves I. III and V and the interpeak intervals I-III. III-V and I-V of the ABR recorded from different age groups of children with congenital zika virus infection and their peers without risk indicators for hearing impairment.
Methods
84 newborns and infants (N=51 study group and N=33 control group) divided into groups with different post-conceptual ages. with the results of their hearing exams analyzed by age group and compared with their peers without other risk indicators for hearing impairment. The assessment of the auditory pathway was conducted through tympanometry. otoacoustic emissions and auditory brain stem responses.
Results
only the latency of wave I and the interpeak III-V showed no significant difference between the study and control groups. The absolute latency and interpeak values found in the study group were significantly lower than those found in the control group.
Conclusion
the maturation of the brain stem in children with ZIKV infection occurred within normal limits. with no retrocochlear disorders until the age of 5 years.
Keywords:
Zika Virus; Evoked Potentials, Auditory, Brain Stem; Hearing; Arbovirus Infections
... Studies already conducted about the power of ZIKV toxicity showed that the virus acts by killing the cells that give rise to neurons. thus impairing the neural communication and causing a diminished cortex and even hypoplasia at the level of the brainstem 13 . A study concluded that the auditory impairment in microcephaly is a common neurodeficit that can be authentically assessed through ABR and that auditory impairment in microcephalic individuals is due to the insufficiency of the central components in the auditory pathway at the level of the brainstem 14 . ...
Purpose
to analyze the absolute latencies of waves I. III and V and the interpeak intervals I-III. III-V and I-V of the ABR recorded from different age groups of children with congenital zika virus infection and their peers without risk indicators for hearing impairment.
Methods
84 newborns and infants (N=51 study group and N=33 control group) divided into groups with different post-conceptual ages. with the results of their hearing exams analyzed by age group and compared with their peers without other risk indicators for hearing impairment. The assessment of the auditory pathway was conducted through tympanometry. otoacoustic emissions and auditory brain stem responses.
Results
only the latency of wave I and the interpeak III-V showed no significant difference between the study and control groups. The absolute latency and interpeak values found in the study group were significantly lower than those found in the control group.
Conclusion
the maturation of the brain stem in children with ZIKV infection occurred within normal limits. with no retrocochlear disorders until the age of 5 years.
Keywords:
Zika Virus; Evoked Potentials, Auditory, Brain Stem; Hearing; Arbovirus Infections
... The symptoms in infected adults were mild, but in the fetuses of women infected during pregnancy, especially in the late first trimester, the disease was extremely severe, with the main alterations of microcephaly and other types of brain damage observed. The disease in fetuses and infants has been called congenital Zika syndrome (CZS), a term proposed because the pathological effects are not limited to microcephaly; indeed, other manifestations of neurological and systemic development [9], such as cortical development reduction, calcifications, ventriculomegaly, abnormalities of the corpus callosum, microencephaly defined as reduced brain volume, and microcephaly, defined as reduced head circumference, have been observed [9][10][11][12]. In addition to brain impairment, congenital arthrogryposis, microphthalmia, dysphagia, and neuromuscular alterations are the most common systemic manifestations. ...
Introduction
Zika virus infection during pregnancy causes fetal microcephaly and brain damage. Congenital Zika syndrome (CZS) is characterized by systemic involvement with diffuse muscle impairment, a high frequency of arthrogryposis, and microphthalmia. Cardiac impairment in CZS has rarely been evaluated. Our study assessed morphology and biventricular cardiac function in children with CZS and advanced neurological dysfunction.
Methods
This cross-sectional study was conducted on 52 children with CZS (Zika group; ZG) and 25 healthy children (control group; CG) in Paraiba, Brazil. Clinical evaluation, electrocardiogram (EKG), and transthoracic echocardiogram (TTE) were performed on all children. Additionally, troponin I and natriuretic peptide type B (BNP) levels, the degree of cerebral palsy, and neuroimaging findings were assessed in the ZG group.
Results
The median age of the study population was 5 years in both groups, and 40.4% (ZG) and 60% (CG) were female. The most prevalent electrocardiographic alteration was sinus arrhythmia in both the ZG (n = 9, 17.3%) and CG (n = 4, 16%). The morphological parameters adjusted for Z score were as follows: left ventricular (LV) end-diastolic diameter in ZG: -2.36 [-5.10, 2.63] vs. CG: -1.07 [-3.43, 0.61], p<0.001); ascending aorta (ZG: -0.09 [-2.08, 1.60] vs. CG: 0.43 [-1.47, 2.2], p = 0.021); basal diameter of the right ventricle (RV) (ZG: -2.34 [-4.90, 0.97] vs. CG: -0.96 [-2.21, 0.40], p<0.01); and pulmonary artery dimension (ZG: -2.13 [-5.99, 0.98] vs. CG: -0.24 [-2.53, 0.59], p<0.01). The ejection fractions (%) were 65.7 and 65.6 in the ZG and CG, respectively (p = 0.968). The left atrium volume indices (mL/m ² ) in the ZG and CG were 13.15 [6.80, 18.00] and 18.80 [5.90, 25.30] (p<0.01), respectively, and the right atrium volume indices (mL/m ² ) were 10.10 [4.90, 15.30] and 15.80 [4.10, 24.80] (p<0.01). The functional findings adjusted for Z score were as follows: lateral systolic excursion of the mitral annular plane (MAPSE) (ZG: 0.36 [-2.79, 4.71] vs. CG: 1.79 [-0.93, 4.5], p = 0.001); tricuspid annular plane systolic excursion (TAPSE) (ZG: -2.43 [-5.47, 5.09] vs. CG: 0.07 [-1.98, 3.64], p<0.001); and the S’ of the RV (ZG: 1.20 [3.35, 2.90] vs. CG: -0.20 [-2.15, 1.50], p = 0.0121). No differences in biventricular strain measurements were observed between the groups. Troponin I and BNP levels were normal in in the ZG. Grade V cerebral palsy and subcortical calcification were found in 88.6% and 97.22% of children in the ZG group, respectively.
Conclusion
A reduction in cardiac dimensions and functional changes were found in CZS patients, based on the TAPSE, S’ of the RV, and MAPSE, suggesting the importance of cardiac evaluation and follow-up in this group of patients.
... Em relação aos achados de neuroimagem na síndrome congênita pelo ZIKV na TC, um deparado comum descrito na literatura é a redução do diâmetro do crânio (microcefalia) associada a uma acentuada redução do volume cerebral, que é mais frequente no primeiro trimestre de gestação com risco de 1% de 13% (OLIVEIRA-SZEJNFELD et al., 2016;ARAGÃO et al., 2016;HAZIN et al., 2016;MEHRJARDI et al., 2016;WERNER et al., 2016;MEHRJARDI et al., 2017;MOORE et al., 2017;ARAGÃO et al., 2017a). A microcefalia pode ser assimétrica e variar de leve (25%) a moderada/grave (75%) (ARAGÃO et al., 2016). ...
... O aspecto incomum do crânio, achado comum na síndrome congênita do ZIKV e incomum em outros casos de microcefalia, é caracterizado por teto craniano colapsado, com suturas predominantemente evertidas e osso na região occipital, em formato de "gaveta", frequentemente associado a escalpo redundante e dobrado. Tais achados podem ser devidos em parte ao crescimento contínuo do crânio e da pele enquanto o tamanho do cérebro está regredindo, ou mesmo que em algum momento o crânio pode ter colapsado até então para ter tamanho maior às custas de ventriculomegalia (OLIVEIRA-SZEJNFELD et al., 2016;ARAGÃO et al., 2016;HAZIN et al., 2016;MEHRJARDI et al., 2016;WERNER et al., 2016;MEHRJARDI et al., 2017;MOORE et al., 2017). INFECÇÃO Um achado incomum, sugerindo a última hipótese, de que a gordura orbital das herniações no crânio em alguns recém-nascidos, pode ser causado por uma deformação súbita do crânio e não por uma infecção direta do olho, como em outros casos uma infecção congênita (OLIVEIRA-SZEJNFELD et al., 2016). ...
... A displasia cortical é um achado comum, ocorrendo entre 94% e 100% dos casos, e tipicamente se apresenta com agiria e paquigiria, que pode variar dependendo do estágio de desenvolvimento cortical em que ocorre a infecção (OLIVEIRA-SZEJNFELD et al., 2016;ARAGÃO et al., 2016;HAZIN et al., 2016;MEHRJARDI et al., 2016;WERNER et al., 2016;VAN DER LINDEN et al., 2016;MEHRJARDI et al., 2017;MOORE et al., 2017;ARAGÃO et al., 2017a;ARAGÃO et al., 2017b). ...
Nesta coletânea, buscou-se agregar uma visão geral e complementar acerca dos avanços científicos, tecnológicos e sociais da saúde, compilando as produções de estudiosos, acadêmicos e profissionais de saúde. Nesse sentido, a obra “Abordagens em medicina: avanços científicos, tecnológicos e sociais” foi proposta com o objetivo de contribuir para a atualização da literatura em saúde e fortalecer as discussões sobre avanços e aplicações de estudos na atenção à saúde em seus diferentes níveis de complexidade. A coletânea é dedicada a estudantes da área da saúde, profissionais de saúde, residentes em saúde, gestores e especialistas que desejem aprofundar conhecimentos em suas áreas e fora de sua especialidade.
... In the last decade in particular, two emerging viruses have gained attention: the Zika virus (ZIKV), after its outbreak in Brazil in 2015 [72], and Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), which is the cause of the ongoing COVID-19 pandemic. ...
... Zika virus is a single-strand RNA flavivirus, transmitted by infected female mosquitos, such as the Aedes mosquito [72]. The in utero infection potentially leads to adverse pregnancy and a variety of severe brain anomalies. ...
... The main clinical feature of congenital Zika infection is microcephaly, often associated with abnormal head shape with overriding sutures and redundant skin folders, probably because of the progressive development of bones and skin in comparison to the arrested brain development [7,72]. Other clinical findings are hypertonia and hyperreflexia, seizures, arthrogryposis, ocular abnormalities, and sensorineural hearing loss. ...
Congenital infections represent a challenging and varied clinical scenario in which the brain is frequently involved. Therefore, fetal and neonatal neuro-imaging plays a pivotal role in reaching an accurate diagnosis and in predicting the clinical outcome. Congenital brain infections are characterized by various clinical manifestations, ranging from nearly asymptomatic diseases to syndromic disorders, often associated with severe neurological symptoms. Brain damage results from the complex interaction among the infectious agent, its specific cellular tropism, and the stage of development of the central nervous system at the time of the maternal infection. Therefore, neuroradiological findings vary widely and are the result of complex events. An early detection is essential to establishing a proper diagnosis and prognosis, and to guarantee an optimal and prompt therapeutic perinatal management. Recently, emerging infective agents (i.e., Zika virus and SARS-CoV2) have been related to possible pre- and perinatal brain damage, thus expanding the spectrum of congenital brain infections. The purpose of this pictorial review is to provide an overview of the current knowledge on fetal and neonatal brain neuroimaging patterns in congenital brain infections used in clinical practice.
... Fetal MRI is considered better at evaluating gyral cortical abnormalities, among them are: polymicrogyria, opercular dysplasia, and lisencephaly-pachygyria 20,21 . When there is evidence of microcephaly and calcifications on fetal ultrasound, it is common to find on MRI some malformations such as ventriculomegaly due to white matter hypoplasia, cerebral atrophy and microphthalmia. ...
... When there is evidence of microcephaly and calcifications on fetal ultrasound, it is common to find on MRI some malformations such as ventriculomegaly due to white matter hypoplasia, cerebral atrophy and microphthalmia. When the evidence is in the white matter or cortices, abnormal myelination and laminar cortical necrosis are observed on MRI T1-and T2-weighted images 11,20 . A very frequent finding is redundancy of the scalp skin in the occipital region of the fetus 11 . ...
OBJECTIVES: To review, identify, and describe the imaging features of congenital zika virus syndrome. METHODS: This is a review with emphasis on magnetic resonance (MRI) and its findings in the diagnosis of congenital zika virus syndrome. Articles, published in the last five years, were searched in PubMed databases. With the descriptors "Zika Virus Infection", "Zika Virus" and "Diagnostic imaging". RESULTS: Twenty-four articles that approached MRI as a complementary tool to ultrasound findings were analyzed. In the fetal period, it is considered better to evaluate abnormalities such as: polymicrogyria, opercular dysplasia, lisencephaly-pachygyria and ventriculomegaly. In the postnatal period it presents high sensitivity and specificity, being the method of choice in the late suspicion of congenital syndrome of ZIKV, in the images it is possible to visualize craniofacial disproportion, microcephaly, cerebral atrophy and reduction of cerebral cortical thickness. CONCLUSION: MRI shows as an important diagnostic method of morphological changes related to zika virus syndrome, contributing to the detailed study of congenital malformations, thus affecting maternal and child health and quality of life.
... 43 The most important finding of congenital zika syndrome on prenatal and postnatal neuroimaging is microcephaly (characterized by head circumference ≥2 standard deviations below the mean for gestational age or below the second percentile for age and sex), 43 accompanied by collapse of the frontal and parietal bones and occipital protrusion, which may be associated with decreased brain volume, subcortical calcifications, and malformations of cortical development, mainly lissencephaly/pachygyria. 44 Posterior fossa malformations such as pons atrophy, a kinking in the pontomedullary junction, cerebellar hemispheres, and vermis hypoplasia associated with cisterna magna enlargement and/or irregular appearance, may also be seen. 45,46 Other possible imaging alterations are thinning of the spinal cord and eye lesions such as coloboma (Fig. 7). ...
Arboviruses are zoonotic RNA viruses maintained in nature in cycles that involve arthropod vectors. The arboviruses that cause disease in humans are members of the Bunyaviridae, Togaviridae, Flaviviridae, and Reoviridae families. These viral species have geographically and climatically restricted distributions due to particular ecological and vector features. The main emerging arboviruses in the Americas are dengue, zika, yellow fever (Flaviviridae), and chikungunya (Togaviridae). All of these viruses can be transmitted by the Aedes aegypti and Aedes albopictus mosquitoes. Although not commonly, these infections are associated with neurological complications, characterized mainly by hemorrhage, encephalitis, myelitis, acute disseminated encephalomyelitis, Guillain-Barré syndrome, and/or congenital malformations. This review describes the imaging features of the neurological complications of these emerging arbovirus infections.
... The supplementary intracranial ultrasound findings include cerebral parenchymal atrophy and the accompanying enlargement of the ventricles, subependymal pseudocysts, anomalies in the eyes, and underdevelopment or absence of the corpus callosum, cerebellum, and brainstem [18]. Parenchymal calcifications may also arise, generally seen at the interface between gray and white matter. ...
... Over time, these calcifications tend to diminish in both size and quantity. Additional discoveries include the consequential consequences of worldwide reduction in cerebral cortical volume, such as enlargement of the brain's ventricles, incongruity between the size of the skull and face, collapse of cranial bones with protrusion of the occipital bone, and diminutive fontanelles [18,20]. CT is especially valuable in monitoring for hydrocephalus after the fontanelles have closed, a condition that affects up to 40% of children and typically requires the implantation of a VP shunt [20]. ...
... However, they become crucial together with the clinical records considering the following scenario: a pregnant woman exposed to ZIKV with no clinical manifestation of the infection and also no evident brain abnormalities in the fetus that could attract attention during prenatal exams. In such cases, the neuroradiological findings described in the CSZ literature ( Table 1; Mehrjardi et al., 2017;Sanz Cortes et al., 2018;de Souza A. S. et al., 2018) should be decisive to provide the diagnosis. ...
The Zika virus (ZIKV) attracted attention due to one striking characteristic: the ability to cross the placental barrier and infect the fetus, possibly causing severe neurodevelopmental disruptions included in the Congenital Zika Syndrome (CZS). Few years after the epidemic, the CZS incidence has begun to decline. However, how ZIKV causes a diversity of outcomes is far from being understood. This is probably driven by a chain of complex events that relies on the interaction between ZIKV and environmental and physiological variables. In this review, we address open questions that might lead to an ill-defined diagnosis of CZS. This inaccuracy underestimates a large spectrum of apparent normocephalic cases that remain underdiagnosed, comprising several subtle brain abnormalities frequently masked by a normal head circumference. Therefore, new models using neuroimaging and artificial intelligence are needed to improve our understanding of the neurobiology of ZIKV and its true impact in neurodevelopment.
