Fig 5.

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).