Congenital Zika virus syndrome comprises a series of fetal malformations, mainly of the central nervous system, that share a pattern of brain atrophy and disorders in neuronal migration, and that have in microcephaly their most striking and severe expression. Ultrasonography plays the most important role in the screening of brain lesions in the fetuses of pregnant women exposed to Zika virus, so the importance of establishing a systematic evaluation in the routine ultrasound controls of pregnant women in areas of transmission of the disease becomes apparent. It is also important to note that fetal neurosonography is the reference standard in the evaluation of fetal brain anatomy and should be part of the diagnostic algorithm in all suspected cases.