Neurological Manifestations Associated With SARS-CoV-2 in Children: A Case Series

Abstract

Neurological manifestations of COVID-19 may affect both central and peripheral nervous systems. Unlike in adults, in whom majority of severe cases derive from respiratory complications, neurological involvement is one of the main causes of severe COVID-19 in children. This study aimed to detect viral respiratory pathogens, mainly SARS-CoV-2, in nasopharynx and cerebrospinal fluid samples utilizing qRT-PCR (TaqMan) in a pediatric population in Brazil. We evaluated four children with neurological symptoms and laboratory-confirmed SARS-CoV-2 infection: three presenting with meningoencephalitis and one presenting with Guillain-Barré syndrome. All four patients had mild respiratory symptoms. SARS-CoV-2 RNA was identified in two cerebrospinal fluid samples. SARS-CoV-2 involvement should be considered for differential diagnosis in pediatric cases presenting neurological alterations even if symptoms such as headache, anosmia, or dizziness are absent.

Comment on: Neurological Manifestations Associated With SARS-CoV-2 in Children: A Case Series

“…We disagree with the statement that the CSF in patient 4 was “indeterminate” as mentioned in Table 1 1 CSF investigations in patient 4 clearly demonstrate dissociation cyto-albuminique, suggesting GBS. We should know if patient 4 underwent nerve conduction studies (NCSs) to determine if neuropathy was of the demyelinating or the axonal type.…”

“…We read with interest the article by Venceslau et al about four pediatric patients with severe neurological complications of a SARS-CoV-2 infection. 1 Three patients developed meningo-encephalitis, of whom two were positive for virus-RNA in the cerebrospinal fluid (CSF), and one patient Guillain-Barre syndrome (GBS). 1 Although one patient required transfer to the intensive care unit (ICU), the outcome was favourable without specific treatment in all of them.…”

“…1 Although one patient required transfer to the intensive care unit (ICU), the outcome was favourable without specific treatment in all of them. 1 The study is appealing but raises concerns that should be discussed.…”

“…We disagree with the statement in the abstract that in adults the majority of severe COVID cases results from respiratory complications. 1 There is ample evidence that adults can also experience severe neurological side effects from SARS-CoV-2 infections. 2,3…”

Diagnostic Pitfalls in Guillain–Barré Syndrome: Case Report and Literature Review

“…Poor outcomes may also be expected in patients with the need for mechanical ventilation, the axonal subtype of GBS, an advanced age at diagnosis and recent Clostridium jejuni infection [ 32 ]. Usually, children present milder forms of disease and better outcomes than adults with GBS [ 52 ].…”