Axial T2-weighted MRI scan of the thoracic spine of a patient positive for ZIKV infection with encephalitis and lower motor neuron signs. The white arrowhead indicates signal hyperintensity in the area of the anterior horn cells. B, Axial, postcontrast, fat-suppressed T1-weighted MRI scan shows gadolinium enhancement of both facial nerves in a patient with Guillain-Barré syndrome positive for ZIKV infection (white arrowhead). C, Axial, postcontrast, fat-suppressed T1-weighted MRI scan of the lumbar spine demonstrates contrast enhancement of the nerve roots and cauda equine in a patient with Guillain-Barré syndrome positive for ZIKV infection (white arrowheads). Courtesy of JAMA
A new article published by JAMA Neurology reports on a study of hospitalized adult patients with new-onset neurologic syndromes who were evaluated for Zika virus infection. The single-center study of 40 patients, include 29 with Guillain-Barré syndrome (GBS), seven with encephalitis, three with transverse myelitis and one with newly diagnosed chronic inflammatory demyelinating polyneuropathy.
Of those 40 patients, 35 (88 percent) had evidence of recent Zika virus infection in the serum (blood) or cerebrospinal fluid, according to the results. Of the patients who were positive for Zika virus infection, 27 had GBS, five had encephalitis, two had transverse myelitis and one had chronic inflammatory demyelinating polyneuropathy, according to the results. The authors note there appeared to be an increase in the incidence of GBS and encephalitis when compared with the period before the outbreak of Zika virus in Brazil.
Limitations of the study include its short time period of only five months and that it was limited to a single neurologic referral center in Rio de Janeiro.
"In this single-center Brazilian cohort, ZIKV [Zika virus] infection was associated with an increase in the incidence of a diverse spectrum of serious neurologic syndromes. The data also suggest that serologic and molecular testing using blood and cerebrospinal fluid samples can serve as a less expensive, alternative diagnostic strategy in developing countries," the article concludes.
Source: The JAMA Network Journals