Severe cortical damage associated with COVID-19 case report

Zombori, Luca; Bacon, Melody; Wood, Hannah; Chatterjee, Fiona; Ramesh, Venkateswaran; Lampariello, Simona; Yoong, Michael

doi:10.1016/j.seizure.2020.11.014

Cited by 12 publications

(9 citation statements)

References 3 publications

(2 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 17 A good recovery was defined as an mRS score of 0–1, reflecting no substantial disability or ongoing symptoms, or back to baseline for those with a pre-existing neurological disorder; those with an mRS scale score of 2–5 were classified as having some degree of disability. 17 The neurological features or imaging findings of 15 cases have been published previously ( appendix pp 7–12 ); 8 , 9 , 18 , 19 these cases were included to reflect the full spectrum of neurological complications of paediatric COVID-19 in the UK.…”

Section: Methodsmentioning

confidence: 99%

Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study

Ray¹,

Abdel‐Mannan

et al. 2021

The Lancet Child & Adolescent Health

Self Cite

131

185

View full text Add to dashboard Cite

Background The spectrum of neurological and psychiatric complications associated with paediatric SARS-CoV-2 infection is poorly understood. We aimed to analyse the range and prevalence of these complications in hospitalised children and adolescents. MethodsWe did a prospective national cohort study in the UK using an online network of secure rapid-response notification portals established by the CoroNerve study group. Paediatric neurologists were invited to notify any children and adolescents (age <18 years) admitted to hospital with neurological or psychiatric disorders in whom they considered SARS-CoV-2 infection to be relevant to the presentation. Patients were excluded if they did not have a neurological consultation or neurological investigations or both, or did not meet the definition for confirmed SARS-CoV-2 infection (a positive PCR of respiratory or spinal fluid samples, serology for anti-SARS-CoV-2 IgG, or both), or the Royal College of Paediatrics and Child Health criteria for paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Individuals were classified as having either a primary neurological disorder associated with COVID-19 (COVID-19 neurology group) or PIMS-TS with neurological features (PIMS-TS neurology group). The denominator of all hospitalised children and adolescents with COVID-19 was collated from National Health Service England data. Findings Between April 2, 2020, and Feb 1, 2021, 52 cases were identified; in England, there were 51 cases among 1334 children and adolescents hospitalised with COVID-19, giving an estimated prevalence of 3•8 (95% CI 2•9-5•0) cases per 100 paediatric patients. 22 (42%) patients were female and 30 (58%) were male; the median age was 9 years (range 1-17). 36 (69%) patients were Black or Asian, 16 (31%) were White. 27 (52%) of 52 patients were classified into the COVID-19 neurology group and 25 (48%) were classified into the PIMS-TS neurology group. In the COVID-19 neurology group, diagnoses included status epilepticus (n=7), encephalitis (n=5), Guillain-Barré syndrome (n=5), acute demyelinating syndrome (n=3), chorea (n=2), psychosis (n=2), isolated encephalopathy (n=2), and transient ischaemic attack (n=1). The PIMS-TS neurology group more often had multiple features, which included encephalopathy (n=22 [88%]), peripheral nervous system involvement (n=10 [40%]), behavioural change (n=9 [36%]), and hallucinations at presentation (n=6 [24%]). Recognised neuroimmune disorders were more common in the COVID-19 neurology group than in the PIMS-TS neurology group (13 [48%] of 27 patients vs 1 [<1%] of 25 patients, p=0•0003). Compared with the COVID-19 neurology group, more patients in the PIMS-TS neurology group were admitted to intensive care (20 [80%] of 25 patients vs six [22%] of 27 patients, p=0•0001) and received immunomodulatory treatment (22 [88%] patients vs 12 [44%] patients, p=0•045). 17 (33%) patients (10 [37%] in the COVID-19 neurology group and 7 [28%] in the PIMS-TS neurology group) were discharged with disabili...

show abstract

Section: Methodsmentioning

confidence: 99%

Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study

Ray¹,

Abdel‐Mannan

et al. 2021

The Lancet Child & Adolescent Health

Self Cite

131

185

View full text Add to dashboard Cite

show abstract

“…1020 records were screened; 963 were excluded after title and abstract screening and 13 were excluded after full-text review. We selected 44 studies for inclusion [ 5 , 12 – 54 ], reporting 59 cases of neurological manifestations in pediatric patients with SARS-CoV-2 infection. Most of the articles were single case reports, 10 were case series.…”

Section: Resultsmentioning

confidence: 99%

“…The median age was 9 years. All children had no comorbidity, except 7 patients with no reported data and 6 patients with underlying conditions: a 3-year-old male with allergy to cow milk [ 24 ], a 6-year-old girl with sickle cell disease, complicated by cerebral vasculopathy, who underwent hematopoietic stem cell transplantation [ 42 ], a 6-year-old male with history of prematurity, chromosome 17 and 19 deletions, submucosal cleft palate, atrial and ventricular septal defects, immune deficit, hypospadias, asthma, obstructive sleep apnea syndrome and gastrostomy [ 49 ], a female with congenital adrenal hyperplasia [ 5 ], a male born preterm [ 52 ] and a 17-year-old female with Cornelia de Lange syndrome [ 54 ]. Four children were under 1 year old: one case of transplacental transmission of SARS-CoV-2 was demonstrated in a neonate born to a mother infected in the last trimester [ 52 ].…”

Section: Resultsmentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…The most commonly used treatment was benzodiazepine and all the patients fully recovered [10][11][12][13][14][15]. Our review of literature looking for diagnosed epilepsy and association with COVID-19 infection in the pediatric population using PubMed [16,17] showed two patients with known epilepsy with worsening seizures in the setting of COVID-19 infection. One patient was well managed on medication for epilepsy and fully recovered from COVID-19 infection.…”

Section: Discussionmentioning

confidence: 96%

New-Onset Seizures as an Acute Presentation With Atypical EEG Findings in a Previously Healthy Child With Asymptomatic COVID-19 Infection

Akbar¹,

Ahmad²

2022

Cureus

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This infection usually presents with upper respiratory symptoms; however, it can also present with a wide variety of other multisystem and neurological symptoms, including seizures. There are several proposed mechanisms by which COVID-19 can cause systemic signs of infections, including neurological complications and seizures.This case report describes a pediatric patient without a previously documented history of epilepsy who was admitted for new-onset focal seizures with impaired consciousness. No other cause and triggers of seizures were found, and the child was tested positive for COVID-19 infection. The patient had six electroclinical seizures during EEG. Video EEG findings showed atypical features of onset of intermittent rhythmic delta activity (IRDA) slowing over the left hemisphere with evolution/generalization of rhythmic delta/theta activity and without clear typical generalized epileptiform discharges. These EEG findings correlated with a clinical change of behavior arrest, staring, and yawning. Similar spells were reported multiple times a day prior to the admission, and past EEG was normal. A review of current literature on COVID-19 and neurological manifestations in children, including new seizures and prior diagnosis of epilepsy, is also provided in this case report.The clinical experience in children with newly diagnosed or chronic epilepsy suggests that exacerbation of seizures, especially from systemic effects such as those caused by severe COVID-19 infection, will be a major concern.

show abstract

Severe cortical damage associated with COVID-19 case report

Cited by 12 publications

References 3 publications

Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study

Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study

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

New-Onset Seizures as an Acute Presentation With Atypical EEG Findings in a Previously Healthy Child With Asymptomatic COVID-19 Infection

Contact Info

Product

Resources

About