Dear Editor:
We read the publication on “Hydrocephalus associated to congenital Zika syndrome and shunting” with a great interest [1]. Jucá et al. concluded that “This series points out the possibility of hypertensive hydrocephalus development in CZS patients. Affected children may benefit from VP shunt insertion. These findings suggest a dual pathology association: fetal brain disruption and primary cortical malformation by the virus itself and hypertensive hydrocephalus [1].” The observation of hydrocephalus in infected infant is totally different from the finding in our country where the infected infant is usually asymptomatic [2] and the neuroimaging usually shows negative finding [3, 4].
Nevertheless, in case that there is hydrocephalus, there is still no specific guideline for management. Placing of shunt might be a good alternative but placing of shunt in Zika virus-infected case should be seriously considered on its risk and benefit. The important possible complication is the shunt failure due to the induction of subclinical meningoventriculitis [5].
References
Jucá E, Pessoa A, Ribeiro E, Menezes R, Kerbage S, Lopes T, Cavalcanti LP (2017) Hydrocephalus associated to congenital Zika syndrome: does shunting improve clinical features? Childs Nerv Syst. https://doi.org/10.1007/s00381-017-3636-2
Wiwanitkit S, Wiwanitkit V (2016) Afebrile, asymptomatic and non-thrombocytopenic Zika virus infection: don’t miss it. Asian Pac J Trop Med 9(5):513. https://doi.org/10.1016/j.apjtm.2016.03.036
Joob B, Wiwanitkit V (2017) Fetal magnetic resonance imaging of fetus with Zika virus infection. Pediatr Neurol 68:e1. https://doi.org/10.1016/j.pediatrneurol.2016.11.009
Wiwanitkit V (2016) Neonatal neuroradiological aspects in Zika virus infection. Childs Nerv Syst 32(8):1349. https://doi.org/10.1007/s00381-016-3102-6
Visagan R, Livermore LJ, Kelly D, Magdum S (2017) Subclinical meningoventriculitis as a cause of obstructive hydrocephalus. BMJ Case Rep 11:2017
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Joob, B., Wiwanitkit, V. Hydrocephalus associated to congenital Zika syndrome and shunting. Childs Nerv Syst 34, 183 (2018). https://doi.org/10.1007/s00381-017-3656-y
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DOI: https://doi.org/10.1007/s00381-017-3656-y