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  • Updated 01.06.2024
  • Released 09.11.2016
  • Expires For CME 01.06.2027

Zika virus: neurologic complications



Zika virus infection, transmitted by a mosquito-borne flavivirus, has always been considered a minor and relatively benign disease restricted to areas of Africa and Asia. This notion of rarity, benignity, and geographical limitation was challenged in 2013 when the virus began to spread rapidly to other regions of the world and started to be associated with neurologic diseases, mainly Guillain-Barré syndrome and congenital malformations of the central nervous system. Issues related to neurologic complications of the Zika virus will be reviewed here. The authors will address epidemiology, clinical features, pathology, diagnosis, treatment, and prevention, highlighting advances in etiopathogenesis.

Key points

• Zika virus is an arthropod-borne (arbovirus) flavivirus transmitted by mosquitoes of Aedes species; the same mosquitoes transmit other viral illnesses, such as yellow fever, Mayaro, dengue, and Chikungunya.

• Zika virus clinical disease, which occurs in approximately 20% to 25% of individuals, is a mild febrile illness associated with a pruritic rash, arthralgia of small joints, and conjunctivitis.

• Although the full extent of the neurologic complications of Zika is not yet known, the two most common complications are congenital malformations (“congenital Zika syndrome”) and Guillain-Barré syndrome.

• Other less common complications are transverse myelitis, encephalopathy, meningoencephalitis, pure sensory neuropathy, and ischemic strokes.

Historical note and terminology

Zika virus was first discovered in 1947 in the Zika forest of Uganda from a sentinel Rhesus monkey with an acute febrile illness (24). The first human cases were subsequently detected in Nigeria (43). Before the major outbreak in 2007 in the Yap Islands in Micronesia (27), where almost three quarters of inhabitants were infected, only sporadic and mild cases were reported from Africa and Southeast Asia (05). Subsequent epidemics occurred in Southeast Asia and Pacific Ocean islands (36). The apparently benign nature of Zika virus infection was disputed after an outbreak in French Polynesia in 2013, where many Guillain-Barré syndrome and other autoimmune complications were described (36). The virus finally arrived in Brazil in mid-2015, rapidly spreading throughout the country and to more than 30 other countries (61). Local transmission in the United States was first reported in Florida and then in Texas. Still, most cases in the United States have been imported from abroad ( The first congenital Zika syndrome cases were described in Northeastern Brazil (70). That was the first time a congenital malformation was attributed to an infection transmitted by mosquitoes.

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