Review of neuroimaging findings in congenital Zika virus syndrome and its relation to the time of infection

Abstract

Background Many original articles and case series have been published emphasizing the neuroimaging findings of congenital Zika virus (ZIKV) infection. The majority of these studies do not follow a neuroradiological methodology to describe malformations and brain abnormalities resulting from ZIKV infection. The cause-and-effect correlation between the gestational period of maternal infection and the severity of encephalic changes at birth has rarely been reported. A systematic literature review was conducted on the neuroimaging findings in children affected with microcephaly due to ZIKV. Methods PubMed, Cochrane Library and Web of Science were searched for full-text articles published up to July 2019. Duplicate entries were removed. Two independent reviewers performed a quality assessment of all the studies included. Results A total of 2214 publications were identified. Of these 2170 were excluded by analysis of titles and abstracts, resulting in the inclusion of only eight articles. Chi-square and Fisher’s exact tests were performed with a 95% confidence interval to verify the statistically significant differences in the neuroradiological findings between the cases of ZIKV infection in the first or second trimester of gestation. The studies published so far have described image abnormalities at random, without utilizing any pre-established neuroradiological criteria, and imaging modalities with different sensitivity and accuracy have been used, which jeopardizes a reliable and adequate statistical analysis. Conclusions Neuroimaging abnormalities are much more prevalent and severe when the infection by ZIKV is contracted in the first or second trimester of pregnancy.

Fetal, neonatal, and infant outcomes associated with maternal Zika virus infection during pregnancy: A systematic review and meta-analysis

“…In a recent systematic review, the prevalence rates of CNS abnormalities were: reduced brain volume (80–81.5%), subcortical calcifications (88.2–93.3%), microcephaly (90–93.3%) and ventriculomegaly (73.3–78.1%). This study also showed that the prevalence of these abnormalities was inversely proportional to the trimester of pregnancy in which the ZIKV infection occurred [ 55 ].…”

“…Some of the cohorts might have captured more women infected in the first and second trimesters and others with more women infected in the third. Recently, some studies have shown that the prevalence of microcephaly appears to be inversely proportional to the trimester of pregnancy in which the exposure takes place [ 20 , 35 , 55 ].…”

“…Ventriculomegaly secondary to congenital infections is the result of a process of cerebral atrophy or inflammatory arachnoid granulations that lead to obstruction of the ventricular system [ 63 ]. Ventriculomegaly is a widespread finding in children with symptomatic congenital Zika syndrome [ 55 ]. The prevalence range of ventriculomegaly, regardless of the aetiology, in the general population, is around 0.06 to 2% of fetuses [ 61 ].…”

The Impact of Maternal Infection on the Neonate

“…A meta-analysis of 42 articles revealed the most common brain abnormalities following ZIKV exposure in utero, including decreased brain volume, increased extra-axial cerebrospinal fluid space, subcortical calcifications, microcephaly, ventriculomegaly, malformation of cortical development, basal ganglia calcifications, and mega cisterna magna [45]. These findings support the concept that ZIKV interferes with normal neuronal migration during development which then impacts the brain development.…”

Longitudinal brain magnetic resonance imaging of children with perinatal Chikungunya encephalitis

“…Despite this, the MRI aspect of brain lesions secondary to mother-to-child CHIKV transmission is different from other congenital infections, such as cytomegalovirus, Zika, rubella and toxoplasmosis, which can cause microcephaly, cerebral calcifications and malformations of cortical development, which are not seen in CHIKV infection. 13–15 In addition, it is important to be aware that on long-term follow-up, patients with perinatal CHIKV infection may experience neurocognitive sequelae and an absence of MRI-detected brain lesions.…”