Common findings on head computed tomography in neonates with confirmed congenital Zika syndrome

Abstract Objective: To describe head computed tomography (CT) findings in neonates with congenital Zika virus infection confirmed in cerebrospinal fluid. Materials and Methods: This was a study of 16 newborn infants who exhibited abnormal head CT findings during an outbreak of Zika virus infection. Those infants had the following features: brain imaging suggestive of congenital infection; brain calcifications and negative results on tests for other main infectious causes of primary microcephaly, namely toxoplasmosis, cytomegalovirus, rubella, and HIV; positivity for Zika virus on IgM antibody capture enzyme-linked immunosorbent assay in cerebrospinal fluid. Results: Decreased brain volume was observed in 13 (81.2%) of the infants. All of the infants showed cortico-subcortical calcifications, mainly located in the frontal lobe. In 15 neonates (93.7%), ventriculomegaly was observed. Colpocephaly was a common finding, being observed in 10 patients (62.5%). A prominent occipital bone was identified in 9 patients (56.2%). Conclusion: Our study proves that Zika virus infection can cause congenital brain damage, with or without microcephaly. Some predominant head CT findings in neonates with congenital Zika virus infection, although not pathognomonic, are strongly suggestive of a pattern.

摘要
研究目的：描述经脑脊液（cerebrospinal fluid）确诊的先天性寨卡病毒（Zika virus）感染新生儿的头部计算机断层扫描（computed tomography, CT）表现。
材料与方法：本研究纳入16名在寨卡病毒感染暴发期间出现头部CT异常表现的新生儿。该类新生儿具备以下特征：脑部影像学检查提示先天性感染；存在颅内钙化，且其他引发原发性小头畸形的主要感染性病因（即弓形虫病、巨细胞病毒感染、风疹病毒感染及人类免疫缺陷病毒（HIV））的检测结果均为阴性；脑脊液中寨卡病毒IgM抗体捕获酶联免疫吸附试验（enzyme-linked immunosorbent assay, ELISA）呈阳性。
结果：13名（81.2%）新生儿出现脑容积减小。所有新生儿均可见皮质-皮质下钙化灶，主要分布于额叶。15名新生儿（93.7%）存在脑室扩大。侧脑室后角扩张为常见影像学表现，10名患儿（62.5%）出现该征象。9名患儿（56.2%）可见枕骨突出。
结论：本研究证实寨卡病毒感染可引发先天性脑损伤，无论患儿是否伴随小头畸形。先天性寨卡病毒感染新生儿的部分典型头部CT表现虽非诊断特异性征象，但强烈提示存在特征性的影像学模式。