The imaging and pathological findings in congenital Zika syndrome include moderate and severe microcephaly, in as many as 75% of the cases [1], ophthalmological and auditory abnormalities [2, 3], and arthrogryposis [4]. However, these are not the only abnormalities that can be found, and the complete disease spectrum is still unknown. Some babies are born with head circumference at the lower limit of the normal range, but later progress to microcephaly. In the authors’ experience, they correspond to about 10% of microcephaly cases confirmed with positive IgM CSF (unpublished data). However, the clinical spectrum of the effects of Zika virus infection during pregnancy is not yet known.