Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: retrospective case series study.

Autor:	de Fatima Vasco Aragao M; 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., van der Linden V; Association for Assistance of Disabled Children, Recife, Brazil; Barão de Lucena Hospital, Recife, Brazil., Brainer-Lima AM; PROCAPE, University of Pernambuco, Recife, Brazil., Coeli RR; Oswaldo Cruz University Hospital, Recife, Brazil., Rocha MA; Oswaldo Cruz University Hospital, Recife, Brazil., Sobral da Silva P; Oswaldo Cruz University Hospital, Recife, Brazil., Durce Costa Gomes de Carvalho M; Oswaldo Cruz University Hospital, Recife, Brazil., van der Linden A; Prof Fernando Figueira Integral Medicine Institute, Recife, Brazil., Cesario de Holanda A; Medical School, Federal University of Pernambuco, Recife, Brazil., Valenca MM; Neurology and Neurosurgery, Federal University of Pernambuco, Recife, Brazil.
Jazyk:	angličtina
Zdroj:	BMJ (Clinical research ed.) [BMJ] 2016 Apr 13; Vol. 353, pp. i1901. Date of Electronic Publication: 2016 Apr 13.
DOI:	10.1136/bmj.i1901
Abstrakt:	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. Design: Retrospective study with a case series. Setting: Association for Assistance of Disabled Children (AACD), Pernambuco state, Brazil. Participants: 23 children with a diagnosis of congenital infection presumably associated with the Zika virus during the Brazilian microcephaly epidemic. Main Outcome Measures: 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. Conclusion: 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. (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
Databáze:	MEDLINE
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