Neuroimaging Findings of Zika Virus–Associated Neurologic Complications in Adults

A 30-year-old woman with Zika virus infection with Guillain-Barré syndrome. Postcontrast sagittal T1-weighted image demonstrates enhancement in the cauda equina nerve roots (long arrow) and lumbar spine ganglia bilaterally (short arrows) following injection with a gadolinium-based contrast agent (A). Axial postcontrast, fat-suppressed T1-weighted MR imaging shows gadolinium enhancement of the facial nerves (B, arrows). Axial postcontrast, fat-suppressed T1-weighted MR imaging shows gadolinium enhancement of the trigeminal nerves (C, arrows).

Spine MR imaging of a 35-year-old man with Zika virus infection and Guillain-Barré syndrome presenting with progressive ascending paralysis that evolved to respiratory distress and decreased level of consciousness. The patient had skin rashes preceded by flulike symptoms 1 week before the development of neurologic symptoms. Postcontrast enhancement is seen in the cauda equina nerve roots (arrows) on sagittal (A) and axial (B) T1-weighted spine images following gadolinium-based contrast agent injection. Axial gradient-echo T2-weighted (C) and FSE T2-weighted (D and E) spine images reveal hyperintensity (arrow) in the anterior horns of the cervical (C) and thoracic spinal cord (D).

Acute myelitis in a patient with Zika virus infection. Spine MR imaging of a 38-year-old woman with unsteadiness and weakness in the lower limbs. Hyperintense, ill-defined lesions are seen in sagittal (A, arrows) and axial (C and D, arrows) T2-weighted images of the cervicothoracic and middle thoracic spinal cord, causing mild expansion of the cord (A). The lesions demonstrate contrast enhancement in the postgadolinium sagittal T1-weighted image (B, arrows).

The same patient as in Fig 3. Zika virus-related Guillain-Barré syndrome associated with brain stem encephalitis and myelitis (encephaloradiculomyelitis). Brain MR imaging of a 35-year-old man positive for Zika infection with Guillain-Barré syndrome who presented with progressive ascending paralysis evolving to respiratory distress and decreased level of consciousness. The patient had skin rashes preceded by flulike symptoms 1 week before the development of neurologic symptoms. Axial and coronal T2-weighted brain images show bilateral hyperintensity (arrows) in the middle cerebellar peduncles (A) and corticospinal tracts bilaterally (B and C). Brain and spine MR imaging performed 2 months after treatment demonstrate improvement of the middle cerebellar peduncle and corticospinal tract hyperintensity (D and E). An absence of contrast enhancement is seen in the conus medullaris and cauda equina nerve roots in the postcontrast sagittal fat-suppressed T1-weighted image (F). Axial T2-weighted spine image reveals improvement of the hyperintensity in the anterior horns of the thoracic spinal cord (G).

Zika virus–related brain stem encephalitis in a 40-year-old man. Axial fluid-attenuated inversion recovery image shows diffuse hyperintensity in the brain stem, especially in the pons and cerebral peduncle (A and B). Axial T2-weighted images show bilateral hyperintensity in the middle cerebellar peduncles (C, arrows). Hyperintensity is also seen in the corticospinal tracts bilaterally in axial (D) and coronal (E) T2-weighted images. These lesions showed no enhancement on postcontrast T1-weighted images (not shown).

Axial T2-weighted images of a 52-year-old man with Zika virus–related brain stem encephalitis and myelitis. Hyperintense lesions are seen in the upper portion of the lateral columns of the cervical spine (A, arrow) and anterior portion of the medulla bilaterally (B, arrow). The brain stem is diffusively involved (C–G), as are the middle cerebellar peduncles (C) and the bilateral corticospinal tracts (G, arrows).

Brain and spine MR imaging of a 48-year-old woman with Zika virus infection and encephalitis and myelitis. Axial T2-weighted image of the brain shows hyperintensity of the middle cerebellar peduncles bilaterally (A, arrows). Short tau inversion recovery sagittal image (B) demonstrates a hyperintense lesion in the upper portion of the anterior spine without enhancement in the sagittal postcontrast T1-weighted image (C). Follow-up MR imaging was performed 2 weeks later.