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

Abstract

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.

A Birth Cohort Follow-Up Study on Congenital Zika Virus Infection in Vietnam

“…As far as we could follow up with children with CZI until 2 or 6 years of age, none of them developed microcephaly at infancy or toddler age. Brain imaging using CT or MRI did not reveal typical findings in CZS, such as delayed myelination, intracranial calcification, ventriculomegaly, cerebellar hypoplasia, or cortical development abnormalities, which are seen in most children with CZS [ 29 ], except for cerebellar hypoplasia in the boy with Down syndrome, which is commonly seen in Down syndrome. Studies on mothers infected with ZIKV during pregnancy in the US territories reported that 4–6% of the babies had microcephaly at birth, and postnatal-onset microcephaly occurred in an additional 1% [ 30 ].…”

Zika virus infection histories in brain development

“…Follow-up brain imaging of microcephalic CZVS patients revealed that the number, size and density of calcifications diminish after 1 year of life. Despite this decrease after birth, the remaining calcifications persist until at least 3 years of age ( Alves et al, 2021 ), suggesting that some can be permanent.…”

Acute neurologic emerging flaviviruses

“…A recent study analyzing neuroimaging of children diagnosed with CZS at 3-year follow-up revealed delayed myelination, persistent intracranial calcifications, ventriculomegaly, cerebellar hypoplasia, and cortical abnormalities on CT. All children included in this analysis displayed severe neurodevelopmental impairment. 128 …”

“…A recent study analyzing neuroimaging of children diagnosed with CZS at 3-year follow-up revealed delayed myelination, persistent intracranial calcifications, ventriculomegaly, cerebellar hypoplasia, and cortical abnormalities on CT. All children included in this analysis displayed severe neurodevelopmental impairment. 128 While the mechanism for these delayed effects is unclear, murine models suggest that Zika infection of oligodendrocytes and subsequent cell death in the post-natal period leads to secondary immune demyelination. 129 It is also possible that ZIKV has M Caldwell, AP Boruah et al…”