RESUMO
In congenital Zika virus syndrome (CZS), the most frequent radiological findings are calcifications in the cortical-white matter junction and malformations of cortical development (pachygyria or polymicrogyria, which occur predominantly in the frontal lobes, or a simplified gyral pattern), ventriculomegaly, enlargement of the cisterna magna and the extra-axial subarachnoid space, corpus callosum abnormalities, and reduced brain volume. This syndrome can also result in a decrease in the brainstem and cerebellum volumes and delayed myelination. Infants with CZS may show venous thrombosis and lenticulostriate vasculopathies. Over a 3-year follow-up period, many infants with CZS showed hydrocephalus, reduction in brain calcifications, and greater reduction in brain thickness.
Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Diagnóstico por Imagem/métodos , Complicações Infecciosas na Gravidez/diagnóstico por imagem , Infecção por Zika virus/congênito , Infecção por Zika virus/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Calcinose/patologia , Calcinose/virologia , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/patologia , Hidrocefalia/virologia , Lactente , Recém-Nascido , Imageamento por Ressonância Magnética , Microcefalia/diagnóstico por imagem , Microcefalia/patologia , Malformações do Sistema Nervoso/diagnóstico por imagem , Malformações do Sistema Nervoso/patologia , Malformações do Sistema Nervoso/virologia , Gravidez , Síndrome , Tomografia Computadorizada por Raios X , Ultrassonografia Pré-Natal/métodos , Zika virus , Infecção por Zika virus/patologiaRESUMO
In the present case series, the cause of death of infants diagnosed with congenital Zika syndrome (CZS) was lung disease (pneumonia and sepsis with massive pulmonary aspiration), probably secondary to dysphagia and reflux. The main findings in infants with a confirmed diagnosis of CZS who died were as follows: (1) calcification and hypoplasia of the lentiform nuclei, hypoplasia of the caudate nuclei, and calcification at the cortical-subcortical junction was noted in all cases (100%) and calcification of the caudate nuclei was noted in 66.7% of cases; (2) calcification in the brainstem and along the lateral wall of the lateral ventricles was noted in only the case with arthrogryposis (33.3%); and (3) lesions in the posterior fossa (hypoplasia of the brainstem and cerebellum) were noted in two cases (66.7%), including the case with arthrogryposis. The findings concerning calcifications and brain malformations obtained from non-contrast computed tomography (CT) demonstrated good agreement with findings obtained from the postmortem pathological analysis; however, CT failed to detect discontinuity of the pia mater with heterotopia, invasion of the cerebral tissue into the subarachnoid space, and discontinuity of the ependyma in the lateral ventricles with gliosis; this last feature was only imaged in the most severe case of extreme microcephaly with a simplified gyral pattern. Only histopathology showed grouped calcifications associated with scattered calcifications suggestive of the neuron morphology.
Assuntos
Encéfalo/diagnóstico por imagem , Complicações Infecciosas na Gravidez/mortalidade , Tomografia Computadorizada por Raios X/métodos , Infecção por Zika virus/congênito , Infecção por Zika virus/mortalidade , Autopsia , Encéfalo/ultraestrutura , Encéfalo/virologia , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Calcinose/mortalidade , Causas de Morte , Feminino , Humanos , Lactente , Pneumopatias/etiologia , Pneumopatias/mortalidade , Microcefalia/etiologia , Microcefalia/mortalidade , Microcefalia/virologia , Gravidez , Sepse/etiologia , Sepse/mortalidade , Síndrome , Zika virus , Infecção por Zika virus/diagnóstico por imagemRESUMO
Objective To compare initial brain computed tomography (CT) scans with follow-up CT scans at one year in children with congenital Zika syndrome, focusing on cerebral calcifications.Design Case series study.Setting Barão de Lucena Hospital, Pernambuco state, Brazil.Participants 37 children with probable or confirmed congenital Zika syndrome during the microcephaly outbreak in 2015 who underwent brain CT shortly after birth and at one year follow-up.Main outcome measure Differences in cerebral calcification patterns between initial and follow-up scans.Results 37 children were evaluated. All presented cerebral calcifications on the initial scan, predominantly at cortical-white matter junction. At follow-up the calcifications had diminished in number, size, or density, or a combination in 34 of the children (92%, 95% confidence interval 79% to 97%), were no longer visible in one child, and remained unchanged in two children. No child showed an increase in calcifications. The calcifications at the cortical-white matter junction which were no longer visible at follow-up occurred predominately in the parietal and occipital lobes. These imaging changes were not associated with any clear clinical improvements.Conclusion The detection of cerebral calcifications should not be considered a major criterion for late diagnosis of congenital Zika syndrome, nor should the absence of calcifications be used to exclude the diagnosis.