Follow-up brain imaging of 37 children with congenital Zika syndrome: case series study [对37名先天性Zika综合征患儿的脑成像随访：病例系列研究]

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BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4188 (Published 13 October 2017)
Cite this as: BMJ 2017;359:j4188

Authors
Natacha Calheiros de Lima Petribu, Maria de Fatima Vasco Aragao, Vanessa van der Linden, Paul Parizel, Patricia Jungmann, Luziany Araújo, Marília Abath, Andrezza Fernandes, Alessandra Brainer-Lima, Arthur Holanda, Roberto Mello, Camila Sarteschi, Maria do Carmo Menezes Bezerra Duarte

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.