Nonmicrocephalic Infants with Congenital Zika Syndrome Suspected Only after Neuroimaging Evaluation Compared with Those with Microcephaly at Birth and Postnatally: How Large Is the Zika Virus "Iceberg"?
Nonmicrocephalic Infants with Congenital Zika Syndrome Suspected Only after Neuroimaging Evaluation Compared with Those with Microcephaly at Birth and Postnatally: How Large Is the Zika Virus "Iceberg"?
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DOI：
10.3174/ajnr.a5216
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发表时间：
2017-07-01
影响因子：
3.5
通讯作者：
Costello, A.
中科院分区：
文献类型：
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作者：
Aragao, M. F. V. V.;Holanda, A. C.;Costello, A.
背景和目的：虽然小头畸形是先天性寨卡病毒综合征最显著的特征，但一些不太严重的病例也开始被认识到。我们的目的是回顾婴儿的神经成像，以发现没有小头症的病例，并将他们与有小头症的婴儿进行比较。材料和方法：我们回顾评估了1岁或以下婴儿的所有神经成像(MR成像/CT)。将先天性寨卡病毒综合征患者分为出生时小头畸形、出生后小头畸形和无小头畸形3组。结果：77例新生儿中，先天性寨卡病毒综合征占24.6%，其中出生时小头畸形占11.7%，出生后小头畸形占9.1%，无小头畸形占3.9%。出生后小头畸形组和无小头畸形组的影像表现在统计学上相似。出生时有小头畸形者与无小头畸形者相比，有统计学意义的差异：脑体积缩小，皮质下交界处外钙化，胼胝体异常，中至重度脑室增大，轴外间隙扩大，枕大池扩大(无小头畸形者均无)，以及多小脑回(唯一无小头畸形的畸形)。有大脑回的趋势(在没有小头畸形的组中不存在)。出生时小头畸形组与出生后小头畸形组相比，在脑回结构简化、皮质-皮质下交界处外钙化、胼胝体异常、中重度脑室增大和轴外间隙扩大等方面存在显著差异。结论：出生时小头畸形中，除多小脑回外，所有患者均出现文献所述的异常。在出生后小头畸形中，唯一未见的异常是皮质-皮质下交界处外的简化的脑回图案和钙化。头部正常的婴儿表现为额叶多小回不对称，皮质-皮质下交界处钙化，轻度脑室增大，髓鞘形成延迟。
BACKGROUND AND PURPOSE: Although microcephaly is the most prominent feature of congenital Zika syndrome, a spectrum with less severe cases is starting to be recognized. Our aim was to review neuroimaging of infants to detect cases without microcephaly and compare them with those with microcephaly.MATERIALS AND METHODS: We retrospectively evaluated all neuroimaging (MR imaging/CT) of infants 1 year of age or younger. Patients with congenital Zika syndrome were divided into those with microcephaly at birth, postnatal microcephaly, and without microcephaly. Neuroimaging was compared among groups.RESULTS: Among 77 infants, 24.6% had congenital Zika syndrome (11.7% microcephaly at birth, 9.1% postnatal microcephaly, 3.9% without microcephaly). The postnatal microcephaly and without microcephaly groups showed statistically similar imaging findings. The microcephaly at birth compared with the group without microcephaly showed statistically significant differences for the following: reduced brain volume, calcifications outside the cortico-subcortical junctions, corpus callosum abnormalities, moderate-to-severe ventriculomegaly, an enlarged extra-axial space, an enlarged cisterna magna (all absent in those without microcephaly), and polymicrogyria (the only malformation present without microcephaly). There was a trend toward pachygyria (absent in groups without microcephaly). The group with microcephaly at birth compared with the group with postnatal microcephaly showed significant differences for simplified gyral pattern, calcifications outside the cortico-subcortical junctions, corpus callosum abnormalities, moderate-to-severe ventriculomegaly, and an enlarged extra-axial space.CONCLUSIONS: In microcephaly at birth, except for polymicrogyria, all patients showed abnormalities described in the literature. In postnatal microcephaly, the only abnormalities not seen were a simplified gyral pattern and calcifications outside the cortico-subcortical junction. Infants with normocephaly presented with asymmetric frontal polymicrogyria, calcifications in the cortico-subcortical junction, mild ventriculomegaly, and delayed myelination.