Neurological Manifestations of COVID-19 in Children

Raj, Sibi; Vasanthi, Thiruvengadam; Baineni, Revanth; Sivabalan, Somu

doi:10.1007/s13312-020-2079-0

Cited by 10 publications

(12 citation statements)

References 8 publications

(8 reference statements)

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“…Many observational studies about clinical characteristics of patients with MIS-C have reported the presence of neurological involvement: children could complain of headache, confusion, altered mental status, stiff neck or meningism [ 10 , 61 – 65 ]. In the course of MIS-C, neurological complications, such as ADEM (our case), pseudotumor cerebri [ 15 , 46 , 51 ], cerebral edema [ 20 , 31 ], seizure [ 40 , 47 ], cerebral stroke [ 45 , 50 ] and cytotoxic lesions of the corpus callosum [ 13 , 17 , 27 , 32 ] have been described and included in this review. During hyperinflammatory state, the corpus callosum, especially the splenium, is highly vulnerable to excess of cytokines and glutamate release from astrocytes because of its high concentration of cytokines and glutamate receptors: this higher density leads to a tendency of cytotoxic edema of the corpus callosum when cytokine storm occurs [ 66 ].…”

Section: Discussionmentioning

confidence: 99%

Neurological complications in pediatric patients with SARS-CoV-2 infection: a systematic review of the literature

Siracusa¹,

Cascio

Giordano³

et al. 2021

Ital J Pediatr

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Objectives To describe clinical characteristics, laboratory tests, radiological data and outcome of pediatric cases with SARS-CoV-2 infection complicated by neurological involvement. Study design A computerized search was conducted using PubMed. An article was considered eligible if it reported data on pediatric patient(s) with neurological involvement related to SARS-CoV-2 infection. We also described a case of an acute disseminated encephalomyelitis (ADEM) in a 5-year-old girl with SARS-CoV-2 infection: this case was also included in the systematic review. Results Forty-four articles reporting 59 cases of neurological manifestations in pediatric patients were included in our review. Most (32/59) cases occurred in the course of a multisystem inflammatory syndrome in children (MIS-C). Neurological disorders secondary to cerebrovascular involvement were reported in 10 cases: 4 children with an ischemic stroke, 3 with intracerebral hemorrhage, 1 with a cerebral sinus venous thrombosis, 1 with a subarachnoid hemorrhage, 1 with multiple diffuse microhemorrhages. Reversible splenial lesions were recognized in 9 cases, benign intracranial hypertension in 4 patients, meningoencephalitis in 4 cases, autoimmune encephalitis in 1 girl, cranial nerves impairment in 2 patients and transverse myelitis in 1 case. Five cases had Guillain-Barré syndrome (GBS) and two, including ours, had ADEM. Radiological investigations were performed in almost all cases (45/60): the most recurrent radiological finding was a signal change in the splenium of the corpus callosum. The presence of SARS-CoV-2 viral nucleic acid in the cerebrospinal fluid was proved only in 2 cases. The outcome was favorable in almost all, except in 5 cases. Conclusions Our research highlights the large range of neurological manifestations and their presumed pathogenic pathways associated with SARS-CoV-2 infection in children. Nervous system involvement could be isolated, developing during COVID-19 or after its recovery, or arise in the context of a MIS-C. The most reported neurological manifestations are cerebrovascular accidents, reversible splenial lesions, GBS, benign intracranial hypertension, meningoencephalitis; ADEM is also a possible complication, as we observed in our patient. Further studies are required to investigate all the neurological complications of SARS-CoV-2 infection and their underlying pathogenic mechanism.

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Section: Discussionmentioning

confidence: 99%

Neurological complications in pediatric patients with SARS-CoV-2 infection: a systematic review of the literature

Siracusa¹,

Cascio

Giordano³

et al. 2021

Ital J Pediatr

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show abstract

“… 76 This also causes respiratory Children with insignificant symptoms are easily misdiagnosed and missed. 77 Children with severe infections may develop acute respiratory distress syndrome, septic shock, metabolic acidosis and coagulopathy. 22 The results of the study showed that the hospitalization and intensive care time, lymphocytosis, and abnormal CT findings (ground-glass opacities and consolidation) of children in the critically ill group were higher than those in non-critically ill children, which are the most reliable factors related to the severity of COVID-19.…”

Section: Clinical Characteristics Of Covid-19 In Childrenmentioning

confidence: 99%

Progress in the Diagnosis and Treatment of COVID-19 in Children: A Review

Wang¹,

Gan²,

Chen³

et al. 2021

IJGM

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“…COVID‐associated encephalopathy has mainly been noted in older patients. 17 But, in recent times, neurological symptoms in children have also been accounted for in the form of isolated case reports and a few combined case studies, 18 , 19 , 20 both in India and across other parts of the world.…”

Section: Discussionmentioning

confidence: 99%