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Follow-up brain imaging of 37 children with congenital Zika syndrome: case series study
Natacha Calheiros de Lima Petribu1,2, Maria de Fatima Vasco Aragao3,4, Vanessa van der Linden5,6
1Barão de Lucena Hospital, Recife, Brazil natachacalheiros@yahoo.com.br.
Insights
Brain CT scans in children with congenital Zika syndrome show diminishing cerebral calcifications over one year. These changes, particularly in the parietal and occipital lobes, do not necessarily correlate with clinical improvement.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Congenital Zika syndrome (CZS) is associated with neurological abnormalities.
- Cerebral calcifications are a common finding in infants with CZS.
Purpose of the Study:
- To compare initial brain CT scans with follow-up CT scans at one year in children with CZS.
- To evaluate changes in cerebral calcification patterns over time.
Main Methods:
- A case series study involving 37 children with probable or confirmed CZS.
- Brain CT scans were performed shortly after birth and at one-year follow-up.
Main Results:
- All 37 children had initial cerebral calcifications, mainly at the cortical-white matter junction.
- In 92% of children, calcifications diminished in number, size, or density by one year.
- No increase in calcifications was observed; changes were most notable in parietal and occipital lobes.
Conclusions:
- Cerebral calcifications in CZS tend to decrease over time.
- Calcification patterns on CT scans should not be the sole basis for diagnosing or excluding CZS.
Abstract:
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.