Zika virus infection: A correlation between prenatal ultrasonographic and postmortem neuropathologic changes

Area of Science:

• Neurology
• Virology
• Radiology

Background:

• Perinatal Zika virus (ZIKV) infection poses significant risks to fetal development.
• Congenital Zika syndrome is characterized by a range of central nervous system (CNS) abnormalities.
• Accurate diagnosis relies on correlating clinical, imaging, and pathological findings.

Observation:

• This study correlated prenatal ultrasound images with postmortem neuropathologic findings in five confirmed perinatal ZIKV cases.
• Mothers presented with ZIKV clinical manifestations or fetal CNS abnormalities.
• Autopsies were performed on two fetal and three early neonatal deaths.

Findings:

• Prenatal ultrasound detected CNS anomalies including craniofacial malformations, cerebellar hypoplasia, corpus callosum anomalies, and ventriculomegaly.
• Ultrasonography revealed brain hyperechogenicities corresponding to calcifications, glial reactivity, and perivascular rings.
• Pathologic findings confirmed the spectrum of CNS anomalies, consistent with the neurotropic effects of ZIKV.

Implications:

• Neuroimaging findings such as unilateral ventriculomegaly, corpus callosum and cerebellum alterations, and calcifications are highly suggestive of ZIKV infection.
• Correlation of prenatal imaging with neuropathology aids in understanding ZIKV's teratogenic effects.
• This study reinforces the utility of neuroimaging in diagnosing congenital Zika syndrome.