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Visualization of Zika Brain Abnormalities - Radiology

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SUPPLEMENTAL TABLES

Tables E1-E2 (PDF)

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SUPPLEMENTAL FIGURES

Figure E1: Axial CT image obtained in a 1-month-old male neonate with a head circumference of 31 cm at birth, with presumed Zika infection. Note moderate ventriculomegaly with ventricular septa in the occipital horns, subcortical calcification, thin parenchymal in occipital regions, and diffuse cortical abnormality.

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Figure E2: Axial CT image obtained in a 1-month-old female neonate with a head circumference of 32 cm at birth, with presumed Zika infection. The image shows asymmetry of the gyri, with focal abnormalities most marked on the left (arrow). Note also the left basal ganglia calcifications.

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Figure E3: Axial CT image obtained in a 6-month-old male infant born with a head circumference of 30 cm, with presumed Zika infection. Note the relatively small frontal lobes, failure of opercularization of the sylvian fissures, and calcifications at the gray matter–white matter junction.

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Images Show Zika's Destruction of Babies' Brains

 

By NBC News

Published 08/23 2016 12:03PM

Updated 08/23 2016 12:03PM

34yr old woman w confirmed Zika virus, initially seen for a rash @ 8 wks of gestation. Fetal head circumference was in the normal range @ 12 & 16 weeks but decreased to 10th % @ 22 wks. Below 3rd percentile in subsequent imaging examinations.
34yr old woman w confirmed Zika virus, initially seen for a rash @ 8 wks of gestation. Fetal head circumference was in the normal range @ 12 & 16 weeks but decreased to 10th % @ 22 wks. Below 3rd percentile in subsequent imaging examinations. /RSNA
  • 160823-zika_fig_03_a880d863c55c385baadc3

The pictures are hard to look at.

Rough ridges appear where a baby's soft skull should be round and smooth. Inside, big patches of white show where brain tissue should be, and isn't.

 

Brazilian and American doctors released a package of scans Tuesday showing the range of destruction that Zika virus can wreak on a developing child. Their aim isn't to horrify, but to help educate radiologists and other specialists about what they need to be on the lookout for as Zika spreads across the Western Hemisphere.

Pregnant women, or women who might become pregnant, are being cautioned to stay away from Zika zones if at all possible, per guidance from the Centers for Disease Control and Prevention and the World Health Organization. But not all women can — especially if they live there.

And the women whose babies are included in the special report in the journal Radiology were affected before WHO and CDC warned the world of the danger caused by a virus that experts all believed was harmless until last year.

The virus is being spread locally in three places in Florida — Miami Beach, an area north of Miami and now in the St. Petersburg area. Health officials expect more U.S. outbreaks.

Brazil has now reported more than 8,000 cases of microcephaly and confirmed that women were infected with Zika in more than 1,600 of them. It's harder to test people for Zika infection after they've recovered.

Dr. Fernanda Tovar-Moll of the D'Or Institute for Research and Education and the Federal University of Rio de Janeiro in Brazil and colleagues examined some of them.

They found a large range of birth defects, from missing brain tissue to deformed limbs. But they focused on what could be seen in images of the brain before and after birth.

Not all babies are born with the characteristically small head, a condition known as microcephaly, they said. Some babies may have brains damaged later in pregnancy, or may have swelling called ventriculomeg­aly that keeps the growing skull supported so that they appear physically normal at birth.

Others have skull deformities caused as the virus destroys brain tissue while bones are still forming.

"The striking imaging features of the severe micrencephaly associated with Zika virus include a markedly abnormal head shape," the team wrote.

"The unusual appearance of the skull, we hypoth­esize, is due to a combination of the small brain as it develops and a result of what, at some point, was likely a larger head size (due to ventriculomeg­aly) that then decompresses," they added.

There are also strange ridges and projections on the heads of some babies and fetuses. "This is also likely due to the head and skin continuing to grow, while the size of the brain regresses," they wrote.

As suspected, the earlier a woman is infected in pregnancy, the worse the damage is. Zika is the first mosquito-borne virus to cause birth defects but other infections are known to cause similar damage -including rubella and cytomegalovirus. But Zika's damage appears to be worse than the damage caused by other infections, the team said.

"The first trimester is the time where infection seems to be riskiest for the pregnancy," said Dr. Deborah Levine, the director of Obstetric & Gynecologic Ultrasound at Beth Israel Deaconess Medical Center and a professor of radiology at Harvard Medical School in Boston.

The team included 438 patients seen from June of 2015 to May 2016. Of them 17 of the babies were confirmed to have been infected with Zika.

The damage did not always immediately show up. The CDC now recommends that pregnant women who have had Zika or suspect they were exposed to it have a series of ultrasounds throughout pregnancy.

"More than one ultrasound or MRI scan in pregnancy may be needed to assess the growth and development abnormalities of the brain," Levine said.

Zika appears to stay in the bodies of developing babies, doing damage over weeks and months. It may also stay in the brain after birth, or at least continue to affect brain development, the researchers said.

"We are also interested in investigating how congenital Zika virus infection can interfere with not only prenatal, but also postnatal gray and white brain maturation," Tovar-Moll said.

What researchers cannot predict is exactly how the brain damage will affect a child - if the baby survives.

"The reality is with all of the technology that we have you can't tell someone that this is what's going happen to your baby," said Dr. Roberta DeBiasi, who helps head the Congenital Zika Virus Program at Children's national health System in Washington, D.C.

"We can't say this baby will survive or not survive or if they survive this is how disabled they are going to be. We just don't have that precision."

Doctors also cannot yet say what percentage of women infected with Zika will have a baby with birth defects. And they cannot say whether the odds are worse if a woman has symptoms from Zika. At least three-quarters of those infected don't remember any specific symptoms.

In this study, the team found that more than 80 percent of the women infected in the first trimester of pregnancy who had Zika-affected babies had the characteristic Zika rash. But they stress their group doesn't represent the population as a whole.

"Thus, we have no information on inci­dence of the Zika virus in the general population or risk estimates for trans­mission to the fetus," they said.

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Zika damage to brain goes well beyond microcephaly, research shows

Study of infants and foetuses in Brazil reveals extent of brain damage caused by mosquito-borne virus

 
MRI images obtained in the case of an 18-year-old woman with confirmed Zika virus infection in Brazil.
 MRI images obtained in the case of an 18-year-old woman with confirmed Zika virus infection in Brazil. Photograph: Reuters

A new report shows in graphic detail the kind of damage Zika infections can do to the developing brain – damage that goes well beyond microcephaly, a birth defect in which the baby’s head is much smaller than normal.

The current Zika outbreak was first detected last year in Brazil, where the virus has been linked to more than 1,800 cases of microcephaly, which can cause severe developmental problems.

Earlier research has shown the Zika virus attacks neural progenitor cells, a type of stem cell that develops into different types of nerve or brain cells.

The latest research, published in the journal Radiology, draws from imaging and autopsy findings linked with confirmed Zika infections done on 17 infants and foetuses cared for at the Instituto de Pesquisa, in Campina Grande in the state of Paraíba in north-eastern Brazil, where the infection has been especially severe.

The study also included reports on 28 foetuses or newborns with brain anomalies whose mothers were suspected of having Zika during pregnancy.

Nearly all babies in each group had ventriculomegaly, a condition in which the ventricles, or fluid-filled spaces in the brain, are enlarged.

While most of the foetuses had at least one exam showing abnormally small head circumference, suggesting they had microcephaly, three of the foetuses with ventriculomegaly had normal head circumference, but severe ventriculomegaly.

Nearly all of the foetuses or babies in the confirmed Zika group and nearly 80% of those in the presumed Zika group also had abnormalities of the corpus callosum, a large bundle of nerves that facilitates communication between the left and right hemispheres of the brain.

In all but one of the cases studied, the researchers found instances in which developing neurons did not travel to their proper destination in the brain.

In many cases, the babies’ skulls seemed to have collapsed on themselves, with overlapping tissues and abnormal skin folds suggestive of a brain that had stopped growing.

“From an imaging standpoint, the abnormalities in the brain are very severe when compared to other congenital infections,” said the study’s co-author Dr Deborah Levine of Beth Israel Deaconess medical centre and a radiology professor at Harvard Medical School.

As with other reports, the paper suggests that Zika does the most harm in the first trimester of pregnancy. The researchers plan to keep following the cases to see what impact prenatal Zika infections have on future brain development.

There is no vaccine or treatment for Zika, which is a close cousin of dengue and chikungunya and causes mild fever, rash and red eyes. An estimated 80% of people infected have no symptoms, making it difficult for pregnant women to know whether they have been infected.

Zika is carried by mosquitoes, which transmit the virus to humans. A small number of cases of sexual transmission have been reported in the US and elsewhere.

https://www.theguardian.com/world/2016/aug/24/zika-damage-to-brain-goes-well-beyond-microcephaly-research-shows

 

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Pictured: How Zika wreaks havoc in a baby's brain and causes the skull to collapse in on itself

  • Study scanned brains of 45 Brazilian babies whose mothers had Zika
  • All had at least one scan suggesting microcephaly - where a baby's brain does not develop properly, causing an abnormally small head
  • Some infants skulls collapsed suggesting the brain had stopped growing
  • Many babies were born with abnormal folds of skin around their skulls 

 

 

These remarkable images reveal in graphic detail how the Zika virus can damage a baby's brain.

Researchers scanned the brains of 45 Brazilian babies whose mothers were affected with the virus. 

 

The images show the damage goes well beyond the devastating birth defect known as microcephaly, in which the baby's head is smaller than normal.

In many cases,  the babies' skulls seemed to have collapsed on themselves, with overlapping tissues and abnormal skin folds suggesting the brain had stopped growing.

These images show how Zika wreaks havoc on baby's brain. Pictured, a photograph of a baby born with an abnormally shaped skull and extra folds of skin. Throughout his 20-year-old mother’s pregnancy scans revealed the foetus had severe ventriculomegaly - a condition in which the ventricles (fluid-filled spaces in the brain) become enlarged

These images show how Zika wreaks havoc on baby's brain. Pictured, a photograph of a baby born with an abnormally shaped skull and extra folds of skin. Throughout his 20-year-old mother’s pregnancy scans revealed the foetus had severe ventriculomegaly - a condition in which the ventricles (fluid-filled spaces in the brain) become enlarged

Scan shows a one week old twin whose 24-year-old mother was infected with the virus, showing the skull collapsing in on itself, suggesting the brain has stopped growing

Scan shows a one week old twin whose 24-year-old mother was infected with the virus, showing the skull collapsing in on itself, suggesting the brain has stopped growing

The twins both suffered from microcephaly, where a baby's brain does not develop properly and therefore its skull is smaller than expected for its age. 

The twins both suffered from microcephaly, where a baby's brain does not develop properly and therefore its skull is smaller than expected for its age. 

The current Zika outbreak was first detected last year in Brazil, where the virus has been linked to more than 1,800 cases of microcephaly, which can cause severe developmental problems.

Prior research has shown the Zika virus attacks neural progenitor cells - a type of stem cell that develops into different types of nerve or brain cells.

The latest research was carried out by the Instituto de Pesquisa, Brazil, an area where the infection has been especially severe. 

 

Nearly all babies in each group had ventriculomegaly, a condition in which the ventricles (fluid-filled spaces in the brain) become enlarged.

Most of the foetuses had at least one exam showing abnormally small head circumference, suggesting they had microcephaly.

However three of the foetuses with ventriculomegaly had normal head circumference, but were suffering from the condition severely.

Nearly all of the foetuses or babies also had abnormalities of the corpus callosum - a large bundle of nerves facilitating communication between the left and right hemispheres of the brain.

Zika Virus - Causes, symptoms, and what can be done
 
 
 
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Most of the foetuses had at least one exam showing abnormally small head circumference, suggesting they had microcephaly. Pictured are two scans of babies with this condition
Pictured, a baby with microcephaly
 

Most of the foetuses had at least one exam showing abnormally small head circumference, suggesting they had microcephaly. Pictured are two scans of babies with this condition

The study revealed babies who were clearly suffering polymicrogyria - a condition characterized by abnormal development of the brain before birth. This baby's mother was 34 years old and a rash suggesting Zika infection was spotted at 8 weeks of gestation

The study revealed babies who were clearly suffering polymicrogyria - a condition characterized by abnormal development of the brain before birth. This baby's mother was 34 years old and a rash suggesting Zika infection was spotted at 8 weeks of gestation

In all but one of the cases studied, the researchers found instances in which developing neurons did not travel to their proper destination in the brain.

And in many, the babies' skulls seemed to have collapsed and it appeared the brain had stopped growing. 

 

'From an imaging standpoint, the abnormalities in the brain are very severe when compared to other congenital infections,' said study co-author Dr Deborah Levine of Beth Israel Deaconess Medical Center, and a radiology professor at Harvard Medical School.

The research confirms previous studies which suggest Zika does the most harm in the first trimester of pregnancy. 

Image shows a baby with a 'markedly abnormal' skull shape
Scan shows a baby with severe microcephaly and extra folds of skin on their skull
 

Scans show babies with a 'markedly abnormal' skull shape (left), severe microcephaly and extra folds of skin on their skull (right)

Some of the babies had normal-sized heads but were suffering from severe ventriculomegaly. Pictured, a photograph of a baby born with limbs that haven't developed properly and deformed joints. It is not clear whether these defects were linked to a Zika infection or not

Some of the babies had normal-sized heads but were suffering from severe ventriculomegaly. Pictured, a photograph of a baby born with limbs that haven't developed properly and deformed joints. It is not clear whether these defects were linked to a Zika infection or not

The team plan to keep following the cases to see what impact a mother becoming infected with Zika has on her baby's future brain development.

There is no vaccine or treatment for Zika, which is a close cousin of dengue and chikungunya and causes mild fever, rash and red eyes. 

An estimated 80 percent of people infected have no symptoms, making it difficult for pregnant women to know whether they have been infected.

Zika is carried by mosquitoes, which transmit the virus to humans. 

However, a small number of cases of sexual transmission have been reported in the US and elsewhere.

The study was published in the journal Radiology.



Read more: http://www.dailymail.co.uk/health/article-3755347/Study-shows-extent-brain-damage-Zika-infections.html#ixzz4IGKbJeCN 
Follow us: @MailOnline on Twitter | DailyMail on Facebook

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