Neurological involvement associated with COVID-19 infection in children

Abstract

We read with great interest the recently published articles regarding neurological involvement associated with COVID-19 infection by Asadi-Pooya et al. and Roman et al. [1,2]. Compared with adult patients, children account for only 1-5% of COVID-19 (SARS-CoV-2) cases, of which more than 80% are asymptomatic or mild cases [3]. SARS-CoV-2 may have neuroinvasive potential because 36% of adult patients are reported to have a variety of neurological manifestations, including headache, dizziness, acute cerebrovascular events, and changes in mental status. [4]. However, another study of 171 Chinese children with COVID-19 infection did not report neurological involvement [5]. According to the latest data from Western countries, non-specific headaches were the only reported neurological symptoms, accounting for 4-28% of COVID-19 infected children [3]. Of note, recent reports described emerging cases diagnosed with multisystem inflammation syndrome in children (MIS-C) related to COVID-19 infection, which share common characteristics with toxic shock syndrome and incomplete Kawasaki disease. [6]. When reviewing 187 children from the six latest reports of MIS-C cases, we found that these children had an unexpectedly high incidence (34%) of neurological involvement [6-11]. Compared with Kawasaki disease shock syndrome (KDSS), which shares several clinical features and severity with MIS-C, the neurological manifestations of KDSS have been found in as high as 54% of the affected children [12]. The high incidence of neurological complications in children with MIS-C Kawasakilike disease remains unclear; nevertheless, the mechanism might be different from the thromboembolic mechanism of the cerebrovascular system observed frequently in adult COVID-19 patients. In these MIS-C cases, 46% and 92% of children were reported positive COVID-19 reverse transcription polymerase chain reaction (RT-PCR) and serum antibody (IgG and/or IgM), respectively. This evidence suggests that while MIS-C occurred, most children might not have an active COVID-19 infection (Table 1). Of the 187 children, 64 had varying degrees of neurological symptoms, most of which were headaches, positive meningeal signs (meningism), and altered mental status. However, although their symptoms strongly implied the need to rule out the

Acute and Post-Acute Neurological Complications of COVID-19

“…The condition was reversible, and the patient achieved full recovery [ 103 ]. Neurological complications of COVID-19 seem to be higher in children with multisystem inflammatory syndrome (MIS-C) [ 104 ]. Reviewing 187 children with MIS-C from six studies showed a high incidence of neurological complications in MIS-C patients with COVID-19.…”

“…Neurological manifestations included headache, meningism and mental status alteration. Interestingly, most patients achieved full recovery with IV immunoglobulins or steroid treatment [ 104 ]. In another study, Abdel-mannan and colleagues reported four cases of MIS-C with COVID-19 neurological complications.…”

Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study

“… 7 It was within this subcohort of COVID-19 cases that neurological manifestations of SARS-CoV-2 infection were first identified in children. 8 A review of multiple studies identified an unexpectedly high incidence of neurological symptoms (34%) in children with MIS-C. 9 …”

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

“…And, in the CNS, the recently described Kawasaki disease (KD)-like “multisystem inflammatory syndrome in children” (MIS-C) following SARS-CoV-2 infection appears to be associated with an acute, neuroinflammatory response, which predisposes children to cerebral edema, hemorrhage, stroke, and aseptic meningitis. 10 …”