Fatal cerebral infarct in a child with COVID-19

Kihira, Shingo; Morgenstern, Peter; Raynes, Hillary; Naidich, Thomas P.; Belani, Puneet

doi:10.1007/s00247-020-04779-x

Cited by 18 publications

(24 citation statements)

References 5 publications

(5 reference statements)

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“…Discharged home on day 15 with only mild residual weakness (strength 4/5) Kihira et al. 35 Pediatric Radiology 2020 5 years Healthy 3 days fever, cough, abdominal pain. Clinically deteriorated, developed cardiogenic shock and placed on venoarterial ECMO.…”

Section: Resultsmentioning

confidence: 99%

“… 50 , 51 Kihira et al. reported a large right anterior and middle cerebral artery infarction with subarachnoid hemorrhage in the left hemisphere in the setting of MIS-C. 35 Even more extensively, Tiwari et al. reported extensive bilateral lesions in a nine-year-old girl with MIS-C and SARS-CoV-2 including smooth stenosis of both internal carotid arteries, both A2 segments of the anterior cerebral arteries, and diffuse narrowing of the M2 and M3 of both middle cerebral arteries.…”

Section: Discussionmentioning

confidence: 99%

“…Mirazee et al and Gulko et al reported cases of focal cerebral arteriopathy involving the left cerebral artery causing damage to the basal ganglia. 50,51 Kihira et al reported a large right anterior and middle cerebral artery infarction with subarachnoid hemorrhage in the left hemisphere in the setting of MIS-C. 35 Even more extensively, Tiwari et al reported extensive bilateral lesions in a nine-year-old girl with MIS-C and SARS-CoV-2 including smooth stenosis of both internal carotid arteries, both A2 segments of the anterior cerebral arteries, and diffuse narrowing of the M2 and M3 of both middle cerebral arteries. 37 The unifying risk factor cited by multiple cases of stroke in children with SARS-CoV-2 infections appears to be a severe acute, neuroinflammatory response.…”

Section: Strokementioning

confidence: 99%

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Coronavirus Infections in the Nervous System of Children: A Scoping Review Making the Case for Long-Term Neurodevelopmental Surveillance

Singer

Evankovich

Fisher

et al. 2021

Pediatric Neurology

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Background The objective of this study was to describe the case literature of human coronavirus infections in the nervous system of children, including from SARS-CoV-2, and to provide guidance to pediatric providers for managing the potential long-term effects on neurodevelopment of human coronavirus infections in the nervous system. Methods Using a structured strategy, the PubMed and Ovid:Embase databases were queried for articles about the clinical presentation and pathophysiology of coronavirus infections in the nervous system of children and young adults, aged 0 to 24 years. Results Of 2302 articles reviewed, 31 described SARS-CoV-2 infections in the nervous system of children and 21 described other human coronaviruses: HCoV-229E, HCoV-NL63, HCoV-OC43, HCoV-HKU1, MERS-CoV, SARS-CoV-1. Excepting MERS-CoV, we found cases of neurological disease in children from each human coronavirus. Children with non-SARS-CoV-2 infections have suffered acute flaccid paralysis, acute disseminated encephalomyelitis, encephalitis, and seizures. In addition, cases of ischemic, hemorrhagic, and microvascular strokes have occurred in children with SARS-CoV-2. Patients with multisystem inflammatory syndrome in children have suffered encephalitis, stroke, pseudotumor cerebri syndrome, and cytotoxic lesions of deep brain structures. Despite these reports, few articles evaluated the impact of human coronavirus infections on long-term neurodevelopmental domains including cognitive, language, academic, motor, and psychosocial outcomes. Conclusions Neurological manifestations of human coronavirus infections can cause severe disease in children. The case literature suggests a critical gap in knowledge of the long-term effects on child neurodevelopment of these infections. As the current SARS-CoV-2 pandemic continues, this gap must be filled to facilitate optimal outcomes in recovering children.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Strokementioning

confidence: 99%

See 1 more Smart Citation

Coronavirus Infections in the Nervous System of Children: A Scoping Review Making the Case for Long-Term Neurodevelopmental Surveillance

Singer

Evankovich

Fisher

et al. 2021

Pediatric Neurology

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show abstract

“…There were seven case series [10,[13][14][15][16][48][49][50], 23 case reports [18][19][20][21][22][23][24][25][28][29][30][31][32][34][35][36][37][38][40][41][42][43]52], and the rest were letters to the editor, brief reports, and a scientific letter. Two studies were international [15,16], twenty studies were from the USA [13,[17][18][19][20]24,[28][29][30]32,33,35,[37][38][39]41,47,48,…”

Section: Study Characteristicsmentioning

confidence: 99%

A Systematic Review of Severe Neurological Manifestations in Pediatric Patients with Coexisting SARS-CoV-2 Infection

O'Loughlin

Toledo

Budrie

et al. 2021

Neurology International

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SARS-CoV-2 infection in children produces mild respiratory symptoms or no symptoms at all in most cases. Some pediatric patients develop a severe complication associated with high mortality, the multisystem inflammatory syndrome in children (MIS-C). In both scenarios, there are reports of neurological manifestations. This article aims to review the cases of pediatric patients with severe neurological issues and a coexisting positive SARS-CoV-2 test. A literature search was performed between March 2020 and May 2021. The results included the data from 41 studies, with 159 children with severe neurological manifestations, within an age range from 24 h to 17 years. The neurological disorders included 38 cases with stroke, 32 with encephalitis, 22 with encephalopathy, and 10 with Guillain–Barre syndrome. Sixty-five out of 159 cases with severe neurological manifestations were diagnosed with MIS-C. Direct neuroinvasion and the exaggerated immune response in some patients seem to be the most critical factors triggering these manifestations. Further research in the ongoing pandemic is needed to elucidate the precise mechanism.

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“…Furthermore, cerebral vasculitis in the context of systemic disease (including Kawasaki disease) or infections (particularly herpes group viruses, like Varicella zoster virus) are considered important precipitants for stroke [ 10 ]. Our patient experienced a massive right cerebral artery ischemia, an alleged finding in the adult population with SARS-CoV-2 infection, but barely reported for children [ 11 , 12 ]. A recent review endeavored to explain the complex neurologic complications framework related to SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 73%

Malignant cerebral infarction associated with COVID-19 in a child

et al. 2021

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Neurological manifestations, such as encephalitis, meningitis, ischemic, and hemorrhagic strokes, are reported with increasing frequency in patients affected by Coronavirus disease 2019 (COVID-19). In children, acute ischemic stroke is usually multifactorial: viral infection is an important precipitating factor for stroke. We present a case of a child with serological evidence of SARS-CoV-2 infection whose onset was a massive right cerebral artery ischemia that led to a malignant cerebral infarction. The patient underwent a life-saving decompressive hemicraniectomy, with good functional recovery, except for residual hemiplegia. During rehabilitation, the patient also developed a lower extremity peripheral nerve neuropathy, likely related to a long-Covid syndrome.

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Fatal cerebral infarct in a child with COVID-19

Cited by 18 publications

References 5 publications

Coronavirus Infections in the Nervous System of Children: A Scoping Review Making the Case for Long-Term Neurodevelopmental Surveillance

Coronavirus Infections in the Nervous System of Children: A Scoping Review Making the Case for Long-Term Neurodevelopmental Surveillance

A Systematic Review of Severe Neurological Manifestations in Pediatric Patients with Coexisting SARS-CoV-2 Infection

Malignant cerebral infarction associated with COVID-19 in a child

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