Magnetic resonance imaging use in detecting neurological abnormalities in Zika virus infection

Severe neurologic complications are associated with Zika virus (ZIKV) infection. Congenital Zika syndrome (CZS) results from vertical transmission of ZIKV from an infected woman to the fetus during pregnancy. The viral transmission occurs through the placenta. The neurological complications of CZS are caused by affection of the neural stem cells by the virus. CZS is characterized by severe microcephaly; decreased brain volume, with parenchymal calcifications; damage to the back of the eye; congenital contractures; and hypertonia. Prenatal and postnatal imaging, particularly magnetic resonance imaging, has a prominent role in detecting microcephaly, brain calcifications, ventriculomegaly, and malformations of cortical development. Neurological complications of postnatal acquired ZIKV infection are also known, such as Guillain-Barre syndrome (GBS), encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM). Although there is no specific imaging finding to distinguish GBS, encephalitis, myelitis, and ADEM secondary to ZIKV to their other causes, the combination of typical imaging finding and clinical history may lead to suspect of ZIKV infection as the pathogenic agent.