{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T09:43:50Z","timestamp":1777974230755,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2019,1,23]],"date-time":"2019-01-23T00:00:00Z","timestamp":1548201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Zika virus (ZIKV) infection appeared in Brazil in 2015, causing an epidemic outbreak with increased rates of microcephaly and other serious birth disorders. We reviewed 102 cases of children who were diagnosed with microcephaly at birth and who had gestational exposure to ZIKV during the outbreak. We describe the clinical, neuroimaging, and neurophysiological findings. Most mothers (81%) reported symptoms of ZIKV infection, especially cutaneous rash, during the first trimester of pregnancy. The microcephaly was severe in 54.9% of the cases. All infants presented with brain malformations. The most frequent neuroimaging findings were cerebral atrophy (92.1%), ventriculomegaly (92.1%), malformation of cortical development (85.1%), and cortical\u2013subcortical calcifications (80.2%). Abnormalities in neurological exams were found in 97.0% of the cases, epileptogenic activity in 56.3%, and arthrogryposis in 10.8% of the infants. The sensorineural screening suggested hearing loss in 17.3% and visual impairment in 14.1% of the infants. This group of infants who presented with microcephaly and whose mothers were exposed to ZIKV early during pregnancy showed clinical and radiological criteria for congenital ZIKV infection. A high frequency of brain abnormalities and signs of early neurological disorders were found, and epileptogenic activity and signs of sensorineural alterations were common. This suggests that microcephaly can be associated with a worst spectrum of neurological manifestations.<\/jats:p>","DOI":"10.3390\/ijerph16030309","type":"journal-article","created":{"date-parts":[[2019,1,24]],"date-time":"2019-01-24T11:12:48Z","timestamp":1548328368000},"page":"309","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Clinical, Neuroimaging, and Neurophysiological Findings in Children with Microcephaly Related to Congenital Zika Virus Infection"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5571-8640","authenticated-orcid":false,"given":"Maria-Lucia","family":"C. Lage","sequence":"first","affiliation":[{"name":"Post-graduate Programme in Health Sciences, Federal University of Bahia School of Medicine, Pra\u00e7a XV de Novembro\u2014Largo do Terreiro de Jesus, 40025-010 Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra L. de","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Pediatric Rehabilitation Centre, Salvador Hospital, SARAH Network of Rehabilitation Hospitals, Avenida Tancredo Neves, Caminho das \u00c1rvores, Salvador, 41820-900 Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paloma A.","family":"Ventura","sequence":"additional","affiliation":[{"name":"Pediatric Rehabilitation Centre, Salvador Hospital, SARAH Network of Rehabilitation Hospitals, Avenida Tancredo Neves, Caminho das \u00c1rvores, Salvador, 41820-900 Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tania B.","family":"Taguchi","sequence":"additional","affiliation":[{"name":"Pediatric Rehabilitation Centre, Salvador Hospital, SARAH Network of Rehabilitation Hospitals, Avenida Tancredo Neves, Caminho das \u00c1rvores, Salvador, 41820-900 Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana S.","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Pediatric Rehabilitation Centre, Salvador Hospital, SARAH Network of Rehabilitation Hospitals, Avenida Tancredo Neves, Caminho das \u00c1rvores, Salvador, 41820-900 Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suely F.","family":"Pinho","sequence":"additional","affiliation":[{"name":"Pediatric Rehabilitation Centre, Salvador Hospital, SARAH Network of Rehabilitation Hospitals, Avenida Tancredo Neves, Caminho das \u00c1rvores, Salvador, 41820-900 Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Onildo T.","family":"Santos-Junior","sequence":"additional","affiliation":[{"name":"Diagnostic Imaging Department, Salvador Hospital, SARAH Network of Rehabilitation Hospital, Avenida Tancredo Neves, Caminho das \u00c1rvoresSalvador, 41820-900 Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clara L.","family":"Ramos","sequence":"additional","affiliation":[{"name":"Bahiana School of Medicine, Bahiana Foundation for Science Development, Dom Jo\u00e3o VI, Salvador, 40290-000 Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristiana M.","family":"Nascimento-Carvalho","sequence":"additional","affiliation":[{"name":"Post-graduate Programme in Health Sciences, Federal University of Bahia School of Medicine, Pra\u00e7a XV de Novembro\u2014Largo do Terreiro de Jesus, 40025-010 Bahia, Brazil"},{"name":"Departament of Paediatrics, Federal University of Bahia School of Medicine, Pra\u00e7a XV de Novembro\u2014Largo do Terreiro de Jesus, 40025-010 Bahia, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,1,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.3201\/eid2110.150847","article-title":"Zika virus outbreak, Bahia, Brazil","volume":"21","author":"Campos","year":"2015","journal-title":"Emerg. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/0035-9203(52)90042-4","article-title":"Zika virus (I). Isolations and serological specificity","volume":"46","author":"Dick","year":"1952","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lowe, R., Barcellos, C., Brasil, P., Cruz, O.G., Alves Hon\u00f3rio, N., Kuper, H., and Carvalho, M.S. (2018). The Zika Virus Epidemic in Brazil: From Discovery to Future Implications. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15010096"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2536","DOI":"10.1056\/NEJMoa0805715","article-title":"Zika virus outbreak on Yap Island, Federated States of Micronesia","volume":"360","author":"Duffy","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2321","DOI":"10.1056\/NEJMoa1602412","article-title":"Zika virus infection in pregnant women in Rio de Janeiro","volume":"2016","author":"Brasil","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1016\/S1473-3099(16)30318-8","article-title":"Association between Zika virus infection and microcephaly in Brazil, January to May, 2016: Preliminary report of a case-control study","volume":"16","author":"Rodrigues","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1590\/0074-02760160085","article-title":"Zika virus damages the human placental barrier and presents marked fetal neurotropism","volume":"111","author":"Noronha","year":"2016","journal-title":"Mem. Inst. Oswaldo Cruz."},{"key":"ref_8","unstructured":"CDC Zika and Pregnancy (2018, August 20). Congenital Zika Syndrome & Other Birth Defects. Available online: https:\/\/www.cdc.gov\/pregnancy\/zika\/testing-follow-up\/zika-syndrome-birth-defects.html."},{"key":"ref_9","first-page":"i1901","article-title":"Clinical features and neuroimaging (CT and MRI) findings in presumed Zika virus related congenital infection and microcephaly: Retrospective case series study","volume":"353","author":"Coeli","year":"2016","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1001\/jama.2016.19006","article-title":"Birth defects among fetuses and infants of US women with evidence of possible Zika virus infection during pregnancy","volume":"317","author":"Honein","year":"2017","journal-title":"JAMA"},{"key":"ref_11","first-page":"i3899","article-title":"Congenital Zika syndrome with arthogryposis: Retroscpective case series study","volume":"354","author":"Filho","year":"2016","journal-title":"BMJ."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1542\/peds.2017-2038F","article-title":"Motor abnormalities and epilepsy in infants and children with evidence of congenital Zika virus infection","volume":"141","author":"Pessoa","year":"2018","journal-title":"Pediatrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1953","DOI":"10.3201\/eid2211.160956","article-title":"Early growth and neurologic outcomes of infants with probable congenital Zika virus syndrome","volume":"22","author":"Ganz","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"917","DOI":"10.15585\/mmwr.mm6534e3","article-title":"Hearing Loss in Infants with microcephaly and evidence of congenital Zika virus infection-Brazil, November 2015-May 2016","volume":"65","author":"Leal","year":"2015","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1860","DOI":"10.4269\/ajtmh.17-1020","article-title":"Seizures as a complication of congenital zika syndrome in early infancy","volume":"98","author":"Felzemburgh","year":"2018","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/j.jaapos.2018.01.009","article-title":"Visual impairment evaluation in 119 children with congenital Zika syndrome","volume":"22","author":"Ventura","year":"2018","journal-title":"J. AAPOS."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.3201\/eid2308.170354","article-title":"Characteristics of dysphagia in infants with microcephaly caused by congenital Zika infection, Brazil, 2015","volume":"23","author":"Leal","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1016\/S0140-6736(14)60932-6","article-title":"International standards for newborn weight, length, and head circumference by gestational age and sex: The Newborn Cross-Sectional Study of the INTERGROWTH-21st Project","volume":"384","author":"Villar","year":"2014","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1212\/WNL.0b013e3181b783f7","article-title":"Practice parameter: Evaluation of the child wilt microcephaly (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society","volume":"73","author":"Ashwal","year":"2009","journal-title":"Neurology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.15585\/mmwr.mm6641a1","article-title":"Update: Interim Guidance for the diagnosis, Evaluation and management of infants with possible congenital zika virus infection- United States, October 2017","volume":"66","author":"Adebanjo","year":"2017","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/pch\/17.10.561","article-title":"Evidence-based milestone ages as a framework for developmental surveillance","volume":"17","author":"Domas","year":"2012","journal-title":"Paediatr. Child Health"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Fran\u00e7a, T.L.B., Medeiros, W.R., Saouza, N.L., Longo, E., Pereira, S.A., Fran\u00e7a, T.B.O., and Souza, K.G. (2018). Growth and development of children with microcephaly associated with congenital Zika Virus Syndrome in Brazil. Int. Resp. Public Health, 15.","DOI":"10.3390\/ijerph15091990"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Ferreira, H.N.C., Schiariti, V., Regalado, I.C.R., Souza, K.G., Pereira, S.A., Fechine, C.P.N.D., and Longo, E. (2018). Functioning and disability profile of children with microcephaly associated with congenital Zika virus infection. Int. J. Environ. Resp. Public Heath, 29.","DOI":"10.3390\/ijerph15061107"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2193","DOI":"10.1056\/NEJMc1603617","article-title":"Computed Tomographic finding in microcephaly associated with zika virus","volume":"374","author":"Hazin","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_25","first-page":"202","article-title":"Congenital brain abnormali] and zika virus: What the radiologist can expect to see prenatally and postnatally","volume":"281","author":"Levine","year":"2016","journal-title":"Radiology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.3174\/ajnr.A5216","article-title":"Nonmicrocephalic Infants with Congenital Zika syndrome suspected only after neuroimaging evaluation compared with those with microcephaly at birth and postnally: How large is the Zika Virus \u201ciceberg\u201d?","volume":"38","author":"Aragao","year":"2017","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.clp.2018.01.005","article-title":"Detection and Prevention of Perinatal Infection cytomegalovirus and zika virus","volume":"45","author":"Wood","year":"2018","journal-title":"Clin. Perinatol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s10096-017-3111-8","article-title":"The pathogenesis of microcephaly resulting from congenital infection: Why is my baby\u2019s headson small?","volume":"37","author":"Frenkel","year":"2018","journal-title":"Euro. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1126\/science.aaf6116","article-title":"Zika virus impairs growth in human neurospheres and brain organoids","volume":"352","author":"Garcez","year":"2016","journal-title":"Science"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Li, C., Armstrong, N., Zhao, H., Hou, W., Liu, J., Chen, C., Wan, J., Zhong, C., Liu, C., and Zhu, H. (2018). Zika virus fatally infects wild type neonatal mice and replicates in central nervous system. Viruses, 10.","DOI":"10.3390\/v10010049"},{"key":"ref_31","first-page":"8","article-title":"A report: The definition and classification of cerebral palsy April 2006","volume":"109","author":"Rosenbaum","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_32","unstructured":"Brazilian Ministry of Heath (2018, August 20). Minist\u00e9rio da Sa\u00fade: Minist\u00e9rio da Sa\u00fade vai distribuir teste r\u00e1pido de Zika, Available online: http:\/\/combateaedes.saude.gov.br\/pt\/noticias\/645-saude-acompanha-avaliacao-de-qualidade-de-teste-de-zik. 2016."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/3\/309\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:28:17Z","timestamp":1760185697000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/3\/309"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,23]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,2]]}},"alternative-id":["ijerph16030309"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16030309","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1,23]]}}}