Neuroimaging in Children Born With Congenital Zika Syndrome: A Cohort Study.

BACKGROUND AND PURPOSE: Neuroimaging findings have been associated with adverse neurologic outcomes in children with congenital Zika virus infection. Our purpose is to describe the brain magnetic resonance imaging (MRI) of children around 3 years of age, born with congenital Zika syndrome. METHODS: This cohort study followed 62 children born with congenital Zika syndrome who had head computed tomography (CT) performed during the first months of life. All these children had clinical, neuroimaging, and serological confirmation of congenital Zika. Around 3 years of age, these children received a brain MRI. RESULTS: In 35 children, we could perform an MRI. All these children had severe impairment in neuromotor development. In general, the examinations showed the same alterations of the CT examinations: delayed myelination (82.8%), intracranial calcification (71.4%) although with decreased intensity and size as compared with previously CT examinations, ventriculomegaly (91.4%), cerebellar hypoplasia (68.5%), and cortical development abnormalities (85.8%). CONCLUSION: The serious brain alterations observed through head CT examinations in children born with congenital Zika syndrome continued to be detected through an MRI examination carried out at around 3 years of age. This indicates a poor prognosis for these children who had a severe neuromotor development delay.

Association of Severe Hydrocephalus With Congenital Zika Syndrome.

Importance: Hydrocephalus is a treatable but potentially fatal complication that has not been previously described in congenital Zika syndrome (CZS). Objective: To describe the clinical features and imaging findings in 24 patients with congenital Zika syndrome (CZS) who developed hydrocephalus. Design, Setting, and Participants: This case series included patients with hydrocephalus who were born in October and November 2015 and followed up until mid-2017 in the 2 largest national referral centers for CZS in Brazil. The participants included consecutively enrolled children with a clinical and laboratorial diagnosis of CZS who developed clinical and/or image findings suggestive of hydrocephalus and who were confirmed to experience increased intracranial hypertension during ventriculoperitoneal shunt procedures. Main Outcomes and Measures: To retrospectively describe clinical and image findings in these 24 patients. Results: This multicenter cohort included 308 patients with CZS; 24 consecutive children were enrolled in this study. These children were aged between 3 to 18 months, and 13 of 24 (54%) were female. All patients presented with at least 1 positive test result for anti-Zika antibodies in cerebrospinal fluid or serum and had classic signs of CZS. At the time of hydrocephalus diagnosis, only 14 of 24 patients (58%) had symptoms and signs suggestive of hydrocephalus (mainly worsening seizures, vomiting, irritability, and/or sudden increase of head circumference percentile). Two of 24 patients (8%) had no symptoms suggestive of hydrocephalus but were found to have reduced brain volume on repeated imaging. Cerebellar or brainstem hypoplasia on baseline imaging were found in 18 of 23 patients (78%). At the second computed tomographic scan, all patients showed a marked increase of ventricular volume, compatible with communicating hydrocephalus, and reduction of brain tissue that was visibly worse than on baseline imaging for the 23 patients with repeated scans. Conclusions and Relevance: We present evidence that hydrocephalus is a complication of CZS in at least a proportion of patients. The clinical spectrum of this condition continues to evolve, but given that presenting signs and symptoms of hydrocephalus can be challenging to recognize in CZS, we provisionally recommend that high suspicion and appropriate monitoring for hydrocephalus should be part of the standard care of patients with CZS.

The myelination process in severely malnourished children: MRI findings.

This study reports cranial magnetic resonance imaging (MRI) findings in children with severe protein energy malnutrition (PEM) performed to determine malnutrition related myelination delay. A total of 20 children aged 2 months to 24 months were included in this study. Eleven (55%) of the children had severe wasting, five (25%) children had edematous malnutrition, and four (20%) children had severe stunting. The MRI findings of two (10%) children, both with severe stunting, indicated myelination delay according to Barkovich et al. (2000) and van der Knaap and Valk criteria 2005. Seventeen (85%) children also had MRI findings of cerebral atrophy. Conclusions indicate that the brain myelination process in the first two years of life of severely malnourished infants, as assessed by MRI, does not show significant delay caused by the nutritional impact on the myelination process.