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INFECTIOUS
DISEASES

Cranial Asymmetry

Versus Microcephaly:

Implications for Practice

During the Zika Virus Epidemic

By Sophia Tsakiri, MD; Nikolaos Zacharias, MD; Jose Garcia, MD, SM; and Lynnette Mazur, MD, MPH

ongenital microcephaly can be the result of genetic, highlight the importance of standardized serial head circumfer-
C teratogenic, mechanical, infectious, and other factors ence measurements as part of the workup for neonatal micro-

affecting the fetal brain. Transient craniofacial asym-
cephaly. Clinical exclusion of transient congenital craniofacial
metries and cranial molding can mimic congenital mi- asymmetries and cranial molding could be a cost-effective first
crocephaly caused by brain abnormalities or neurotropic step in the diagnostic workup of microcephaly.
infectious pathogens, including Zika. We present two neonates
who were born with head circumference at or below the 3rd per- Introduction
centile for gestational age, and had improving head measurements Anthropometrics are used prenatally and postnatally to assess
at discharge from the nursery and resolution of the microcephaly fetal and neonatal growth. Head size is a proxy for brain growth.
by the second month of life. The diagnostic workup of the first Microcephaly may originate in utero and can be the result of ge-
patient revealed congenital cranial bone asymmetry and molding, netic, teratogenic, mechanical, infectious, and other factors affecting
and the second patient's workup revealed cranial molding. Other the fetal brain. Congenital Zika virus (ZIKV) syndrome is a leading
etiologies for their microcephaly were excluded. These two cases cause of microcephaly in endemic areas.

18 San Antonio Medicine • May 2018