Aragao M F V V, Holanda A C, Brainer-Lima A M, Petribu N C L, Castillo M, van der Linden V, Serpa S C, Tenório A G, Travassos P T C, Cordeiro M T, Sarteschi C, Valenca M M, Costello A
From the Centro Diagnostico Multimagem (M.F.V.V.A.), Recife, Brazil
Federal University of Pernambuco (A.C.H.), Recife, Brazil.
AJNR Am J Neuroradiol. 2017 Jul;38(7):1427-1434. doi: 10.3174/ajnr.A5216. Epub 2017 May 18.
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.
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.
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.
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.
尽管小头畸形是先天性寨卡综合征最显著的特征，但一种病情较轻的病例谱正开始被认识。我们的目的是回顾婴儿的神经影像学检查，以发现无小头畸形的病例，并将其与有小头畸形的病例进行比较。
我们回顾性评估了所有1岁及以下婴儿的神经影像学检查（磁共振成像/计算机断层扫描）。先天性寨卡综合征患者被分为出生时小头畸形、出生后小头畸形和无小头畸形三组。对三组的神经影像学检查结果进行比较。
77例婴儿中，24.6%患有先天性寨卡综合征（11.7%出生时小头畸形，9.1%出生后小头畸形，3.9%无小头畸形）。出生后小头畸形组和无小头畸形组的影像学表现具有统计学相似性。出生时小头畸形组与无小头畸形组相比，在以下方面存在统计学显著差异：脑容量减小、皮质 - 皮质下交界区外钙化、胼胝体异常、中度至重度脑室扩大、脑外间隙增宽、枕大池扩大（无小头畸形者均无上述表现）以及多小脑回（是无小头畸形者唯一出现的畸形）。有巨脑回的趋势（无小头畸形组未出现）。出生时小头畸形组与出生后小头畸形组相比，在脑回模式简化、皮质 - 皮质下交界区外钙化、胼胝体异常、中度至重度脑室扩大和脑外间隙增宽方面存在显著差异。
在出生时小头畸形患者中，除多小脑回外，所有患者均表现出文献中描述的异常。在出生后小头畸形患者中，未出现的唯一异常是脑回模式简化和皮质 - 皮质下交界区外钙化。头围正常的婴儿表现为不对称性额部多小脑回、皮质 - 皮质下交界区钙化、轻度脑室扩大和髓鞘形成延迟。
