Child's Nervous System

, Volume 34, Issue 1, pp 101–106 | Cite as

Hydrocephalus associated to congenital Zika syndrome: does shunting improve clinical features?

  • Eduardo JucáEmail author
  • André Pessoa
  • Erlane Ribeiro
  • Rafaela Menezes
  • Saile Kerbage
  • Thayse Lopes
  • Luciano Pamplona Cavalcanti
Focus Session



Congenital Zika syndrome (CZS) is a new entity with little information about its course and natural history. It is known that prenatal infection by Zika virus is associated to disrupted nervous system development, leading to typical neurological disabilities and deformities. Some children present progressive ventriculomegaly and hydrocephalus associated to aggravation of seizures and neurological impairment. The aim of this study is to evaluate the development of hydrocephalus and the impact of ventriculoperitoneal shunt insertion in the clinical condition of these children.


Data was obtained from chart review, direct interviews with patients’ parents, direct neurological examination, and analysis of pre- and postoperative neuroimages.


A group of 115 patients had CZS diagnosis from November 2015 to July 2017. Among them, 21 (18.3%) patients had ventricular enlargement noted on follow-up CT scans. Six children (28.6%) underwent a ventriculoperitoneal shunt and all had some improvement after surgery concerning either waking time during the day and better interaction. Overall improvement was also noted in seizures. Spasticity decrease and more cervical control were also achieved. In two out of six cases, a slight increase in parenchymal length could be noted on the CT scans.


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. This is already seen in some cases of congenital rubella, toxoplasmosis, or cytomegalovirus-associated hydrocephalus.


Zika virus Microcephaly Hydrocephalus Ventriculoperitoneal shunt 


Compliance with ethical standards

Conflict of interest

All authors declare that there is no conflict of interests to be disclosed.


  1. 1.
    Petersen LR, Jamieson DJ, Powers AM, Honein MA (2016) Zika virus. N Engl J Med 374(16):1552–1563. CrossRefPubMedGoogle Scholar
  2. 2.
    Younger DS (2016) Epidemiology of Zika virus. Neurol Clin 34:1049–1056. CrossRefPubMedGoogle Scholar
  3. 3.
    Schuler-Faccini L, Ribeiro EM, Feitosa IML et al (2016) Possible association between Zika virus infection and microcephaly-Brazil, 2015. MMMWR Morbility Mortal Wkly Rep 65:59–62.  10.15585/mmwr.mm6503e2 CrossRefGoogle Scholar
  4. 4.
    Heukelbach J, Alencar CH, Kelvin AA, Oliveira WK, Pamplona de Góes Cavalcanti L (2016) Zika virus outbreak in Brazil. J Infect Dev Ctries 10(2):116–120. CrossRefPubMedGoogle Scholar
  5. 5.
    Olagnier D, Muscolini M, Coyne CB et al (2016) Mechanisms of Zika virus infection and neuropathogenesis. DNA Cell Biol 35:367–372. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Moore CA, Staples JE, Dobyns WB et al (2016) Characterizing the pattern of anomalies in congenital Zika syndrome for pediatric clinicians. JAMA Pediatr:1–8.
  7. 7.
    del Campo M, Feitosa IML, Ribeiro EM et al (2017) The phenotypic spectrum of congenital Zika syndrome. Am J Med Genet Part A 173:841–857. CrossRefPubMedGoogle Scholar
  8. 8.
    Van der Linden V, Pessoa A, Dobyns W et al (2016) Description of 13 infants born during October 2015–January 2016 with congenital Zika virus infection without microcephaly at birth — Brazil. MMWR Morb Mortal Wkly Rep 65:1343–1348.  10.15585/mmwr.mm6547e2 CrossRefPubMedGoogle Scholar
  9. 9.
    Cavalcanti LP, Ribeiro EM, Pessoa AL, Carvalho FH, Neto MM, Araújo FM et al (2017b) Microcephaly in Infants, Ceará State, Brazil, 2015–2016. Rev Med UFC 57(1):30–35CrossRefGoogle Scholar
  10. 10.
    Alves LV, Di D, Sousa C (2016) Crises epilépticas em crianças com síndrome congênita do Zika vírus. Rev Bras Saúde Matern Infant 16:33–37. Google Scholar
  11. 11.
    Pastula DM, Yeargin-Allsopp M, Kobau R (2017) Enhanced epilepsy surveillance and awareness in the age of Zika. JAMA Neurol.
  12. 12.
    Kaiser G (1985) Hydrocephalus following toxoplasmosis. Z Kinderchir 40(Suppl 1):10–11. PubMedGoogle Scholar
  13. 13.
    Hutson SL, Wheeler KM, McLone D et al (2015) Patterns of hydrocephalus caused by congenital Toxoplasma gondii infection associate with parasite genetics. Clin Infect Dis 61:1831–1834. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Jones J, Lopez A, Wilson M (2003) Congenital toxoplasmosis. Am Fam PhysicianGoogle Scholar
  15. 15.
    Bale JF, Bray PF, Bell WE (1985) Neuroradiographic abnormalities in congenital cytomegalovirus infection. Pediatr Neurol 1:42–47. CrossRefPubMedGoogle Scholar
  16. 16.
    Malinger G, Lev D, Zahalka N et al (2003) Fetal cytomegalovirus infection of the brain: the spectrum of sonographic findings. Am J Neuroradiol 24:28–32PubMedGoogle Scholar
  17. 17.
    Ribeiro EM, Lopes TF, Kerbage SC, Pessoa ALS, Cavalcanti LPG (2017) From the perception of a cluster of cases of children with microcephaly to congenital Zika syndrome in Brazil: the lessons we have learned and the challenges that lie ahead of us. J Venomous Anim Toxins Incl Trop Dis 23:15. CrossRefGoogle Scholar
  18. 18.
    Verçosa I, Carneiro P, Verçosa R et al (2017) The visual system in infants with microcephaly related to presumed congenital Zika syndrome. J Am Assoc Pediatr Ophthalmol Strabismus.
  19. 19.
    Ventura CV, Maia M, Dias N et al (2016) Zika: neurological and ocular findings in infant without microcephaly. Lancet 387:2502. CrossRefPubMedGoogle Scholar
  20. 20.
    Cavalheiro S, Lopez A, Serra S et al (2016) Microcephaly and Zika virus: neonatal neuroradiological aspects. Childs Nerv Syst 32:1057–1060. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Nishiyama K, Yoshimura J, Fujii Y (2015) Limitations of neuroendoscopic treatment for pediatric hydrocephalus and considerations from future perspectives. Neurol Med Chir (Tokyo) 55:611–616. CrossRefGoogle Scholar
  22. 22.
    Rajshekhar V, Moorthy R (2011) Endoscopic third ventriculostomy for hydrocephalus: a review of indications, outcomes, and complications. Neurol India 59:848. CrossRefPubMedGoogle Scholar
  23. 23.
    Venkataramana N (2011) Hydrocephalus Indian scenario—a review. J Pediatr Neurosci 6:11. CrossRefGoogle Scholar
  24. 24.
    Hahnel S (1992) Inflammatory diseases of the brain in childhood. AJNR 13:551–567Google Scholar
  25. 25.
    Bale JF (2009) Fetal infections and brain development. Clin Perinatol 36:639–653. CrossRefPubMedGoogle Scholar
  26. 26.
    Toma AK (2015) Hydrocephalus. Surg 33:384–389. Google Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Eduardo Jucá
    • 1
    • 2
    • 3
    Email author
  • André Pessoa
    • 2
    • 4
  • Erlane Ribeiro
    • 2
    • 3
  • Rafaela Menezes
    • 3
  • Saile Kerbage
    • 2
  • Thayse Lopes
    • 3
  • Luciano Pamplona Cavalcanti
    • 5
  1. 1.Universidade de Fortaleza (UNIFOR)FortalezaBrazil
  2. 2.Hospital Infantil Albert SabinFortalezaBrazil
  3. 3.Centro Universitário ChristusFortalezaBrazil
  4. 4.Universidade Estadual do Ceará-UECEFortalezaBrazil
  5. 5.Universidade Federal do CearáFortalezaBrazil

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