This study presents a correlation between prenatal US and neuropathological images of postmortem tissue samples from five confirmed cases of perinatal ZIKV infection belonging cohort of the ZEN Initiative at Bucaramanga, Colombia. Deaths occurred between June 2016 and March 2017. Mothers consulted with ZIKV infection clinical manifestations or fetal CNS abnormalities or both. A detailed US scan and neurosonographic protocol was performed by maternal fetal specialists. Perinatal autopsies were performed following the Colombian Health National Institute ZIKV protocol. The autopsies were from two fetal deaths, and three early neonatal deaths. Gestational age was between 262/7 and 382/7 weeks. Two cases were classified as mild microcephaly. Few findings by US and pathology were found in case #1 because it had a late infection; the other cases presented findings corresponding to congenital Zika syndrome: craniofacial malformations, cerebellar hypoplasia, anomalies of the corpus callosum and ventriculomegaly, all confirmed in autopsy specimens. In US, hyperechogenicities were seen in several brain structures, which correspond to cortical and periventricular calcifications, subependimal glial reactivity and perivascular rings. The US and pathological findings show a wide spectrum of CNS anomalies. The histological studies confirm the neurotropic effect of the ZIKV that produce disruptive events, more commonly found in early infections, most of them with a representative image in the US studies. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.