RSNA 2016

Abstract Archives of the RSNA, 2016


NR394-SD-WEB2

Neuroradiological Findings Related to Zika Epidemic: Experience from a Brazilian University Hospital

Wednesday, Nov. 30 12:45PM - 1:15PM Room: NR Community, Learning Center Station #2



Awards
Student Travel Stipend Award

Emerson d. Casagrande, MD, Niteroi, Brazil (Presenter) Nothing to Disclose
Cristina A. Fontes, MD, Niteroi, Brazil (Abstract Co-Author) Nothing to Disclose
Alair Augusto S. Santos, MD, Niteroi, Brazil (Abstract Co-Author) Nothing to Disclose
Victor M. Bussed, Niteroi, Brazil (Abstract Co-Author) Nothing to Disclose
Daniel G. Neves, MD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Alessandro S. Melo, MD, PHD, Niteroi, Brazil (Abstract Co-Author) Nothing to Disclose
Edson Marchiori, MD, PhD, Rio de Janeiro, Brazil (Abstract Co-Author) Nothing to Disclose
Pamela Santos, Niteroi, Brazil (Abstract Co-Author) Nothing to Disclose
PURPOSE

Present the imaging aspects in the three target groups affected by Zika virus infection, as follows: adults who developed acute neurological syndrome, newborns with vertical infection with neurological disorders and pregnant women who presented suggestive exantematic fever syndrome by Zika.

METHOD AND MATERIALS

Since January 2016 we received patients with exanthematic fever suggesting Zika to perform imaging exams, and we divided these patients, as described. Neural axis MRI were performed in adult patients with acute neurological syndrome after exantematic fever suggestive of Zika infection. Newborns with microcephaly whose mothers had exantematic fever underwent brain MRI, some also with US and CT, and histopathological study of the placenta. Fetal MRI was performed in pregnant women who had have exantematic fever. There is a limited ability for laboratory confirmation of Zika in the locations affected by the epidemic, so that exantematic fever was considered as a marker for infection. Patients were scanned  with a 1,5T MRI, and in adults using a protocol with pre and post contrast acquisitions.

RESULTS

Most adult patients presented with symptoms of Guillain-Barré syndrome and variants, a few patients presented encephalomyelitis. The most common finding was lumbar root enhancement followed by lumbar dorsal ganglia enhancement and facial nerve enhancement. Other findings included brain stem lesions with high T2/FLAIR signal, spinal cord lesions with high T2/FLAIR signal, and trigeminal nerve enhancement. We found good correlation of symptoms and imaging findings. In newborns MRI and fetal MRI showed anatomical changes in the brain parenchyma and orbital injuries.

CONCLUSION

MRI was used in clinical investigation of adult patients, excluding other common diseases in this age group, helping in the differential diagnosis, given the limited availability of specific serologic tests for Zika in Brazil. We observed acute neurological syndromes related to Zika, such as Guillain-Barré syndrome and Miller Fisher variant, Bickerstaff syndrome, and encephalomyelitis. In newborns and fetuses anatomical changes can be related to gestational age which pregnant had the exantematic fever.

CLINICAL RELEVANCE/APPLICATION

MRI is a sensitive tool for demonstrating signs of Guillain-Barré syndrome and encephalomyelites associated with Zika virus. In newborns and fetuses, MRI helped us understand the injuries that occur in the developing brain, as other TORCH.