Is a Brain Stroke Caused by the COVID-19 Seen Under Two Years of Age? A Case Report

Abstract

Introduction: Brain ischemic stroke in children especially in infancy is a rare condition. Stroke presents with a variety of symptoms and usually is an underestimated diagnosis in infants. The current pandemic of novel coronavirus disease type 2 (COVID-19), involves different organs in the human body, like the central nervous system. Researchers believe that there is a probable association between this retroviral infection and stroke but there were a few cases of strokes in the pediatrics field with positive RT-PCR for SARS-CoV-2. Case presentation: Herein we introduce a 17-month-old girl with a hemiparesis and focal status epilepticus that was admitted to Firoozabadi hospital. The onset of symptoms was approximately 4 days before the admission with non-bloody, watery diarrhea, nausea, vomiting, and low-grade fever. The brain MRI with DWI sequence confirmed acute ischemic stroke (AIS). Because of her multisystemic involvement, the COVID-19 RT-PCR test was requested and the result was positive. So according to the positive PCR test and negative of other results along with fever and gastrointestinal involvement picture - which is a common form of COVID-19 infection in pediatric patients- her neurological symptoms could be explainable with COVID-19 infection. Based on our knowledge, this is the first case of acute ischemic stroke (AIS) due to SARS CoV-2 infection that was reported under two years of age in the world. Conclusion: COVID-19 infection in pediatric patients has different presentations. In a significant number of these patients, the involvement of more than 2 body organs could be seen, known as “Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19). There are some reports of stroke due to COVID-19 infection and it's related to hypercoagulability state so far and we introduce one infant case of that. According to this new emerging coronavirus and probability of nervous system involvement with this virus, we recommended checking the COVID-19 RT-PCR test in nasopharynx and cerebrospinal fluid of all children presented with neurological symptoms, even in the post-COVID-19 era.