COVID-19 associated arterial ischaemic stroke and multisystem inflammatory syndrome in children: a case report

Tiwari, Lokesh; Shekhar, Shashank; Bansal, Anand; Kumar, Subhash

doi:10.1016/s2352-4642(20)30314-x

Cited by 47 publications

(69 citation statements)

References 18 publications

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“…Further, the exclusion of adult studies may limit our understanding of the pathophysiology and additional clinical manifestations of HCoV in the nervous system, although the presented pediatric neurological manifestations have also been reported in adults. 37 In addition, we did not identify evidence of long-term neurodevelopmental sequelae in adults who had severe HCoV infections as children. Finally, our study is limited, inherently, by the novel nature of the SARS-CoV-2 pandemic.…”

Section: Discussionmentioning

confidence: 63%

“…Brain MRI: unremarkable Serum: interleukin-6 elevated at 5651 pg/mL (normal < 17.4 pg/mL), Echocardiography: left ventricular ejection fraction of 58% and mild coronary artery dilation ( z score < 2.5) 11 days after presentation returned to cognitive baseline, spontaneous movement, and speech; affect was reactive and appropriate; attention, concentration, and short-term memory were all improved Tiwari et al. 37 The Lancet 2020 9 years Healthy 14 days high-grade fever, throbbing frontal headache, vomiting, and progressive weakness on the right side of the body. On presentation GCS of 11, upper motor neuron-type right-sided seventh cranial nerve palsy, complete hemiplegia, brisk deep tendon reflexes, and extensor plantar response on the right, normal pupils, no signs of meningeal irritation Stroke Nasopharyngeal RT-PCR was positive on admission CSF: 50 WBC (lymphocytes 80%, polymorphs 20%), glucose 45, protein 60 mg/dL, negative microbiology.…”

Section: Resultsmentioning

confidence: 99%

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

Singer

Evankovich

Fisher

et al. 2021

Pediatric Neurology

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Background The objective of this study was to describe the case literature of human coronavirus infections in the nervous system of children, including from SARS-CoV-2, and to provide guidance to pediatric providers for managing the potential long-term effects on neurodevelopment of human coronavirus infections in the nervous system. Methods Using a structured strategy, the PubMed and Ovid:Embase databases were queried for articles about the clinical presentation and pathophysiology of coronavirus infections in the nervous system of children and young adults, aged 0 to 24 years. Results Of 2302 articles reviewed, 31 described SARS-CoV-2 infections in the nervous system of children and 21 described other human coronaviruses: HCoV-229E, HCoV-NL63, HCoV-OC43, HCoV-HKU1, MERS-CoV, SARS-CoV-1. Excepting MERS-CoV, we found cases of neurological disease in children from each human coronavirus. Children with non-SARS-CoV-2 infections have suffered acute flaccid paralysis, acute disseminated encephalomyelitis, encephalitis, and seizures. In addition, cases of ischemic, hemorrhagic, and microvascular strokes have occurred in children with SARS-CoV-2. Patients with multisystem inflammatory syndrome in children have suffered encephalitis, stroke, pseudotumor cerebri syndrome, and cytotoxic lesions of deep brain structures. Despite these reports, few articles evaluated the impact of human coronavirus infections on long-term neurodevelopmental domains including cognitive, language, academic, motor, and psychosocial outcomes. Conclusions Neurological manifestations of human coronavirus infections can cause severe disease in children. The case literature suggests a critical gap in knowledge of the long-term effects on child neurodevelopment of these infections. As the current SARS-CoV-2 pandemic continues, this gap must be filled to facilitate optimal outcomes in recovering children.

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Section: Discussionmentioning

confidence: 63%

Section: Resultsmentioning

confidence: 99%

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

Singer

Evankovich

Fisher

et al. 2021

Pediatric Neurology

View full text Add to dashboard Cite

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“…These may range from mild skin rashes to severe vasculitis manifesting as severe arterial strokes. Tiwari et al 4 described a 9-year-old girl with COVID-19associated arterial ischaemic stroke and multisystem inflammatory syndrome who survived. 4 Vasculitis refers to the inflammation of blood vessels which leads to tissue destruction with or without organ damage.…”

Section: Discussionmentioning

confidence: 99%

Leucocytoclastic vasculitis secondary to COVID-19 infection in a young child

et al. 2021

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The current case report describes a 13-year-old young boy who presented with purpuric rashes following a completely asymptomatic COVID-19 infection and biopsy-confirmed leucocytoclastic vasculitis, mild haematuria and mild elevation of serum IgA. This case highlights one of the dermatological manifestations of COVID-19 infection which has not been reported so far. Paediatricians should explore the history of this infection when evaluating any child presenting with a vasculitic rash.

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“…One had refractory shock and extracorporeal membrane oxygenation (ECMO) support; stroke occurence in the anterior and middle cerebral arteries was probably related to thromboembolic disorders related to ECMO (8). One recent report of a 9-year-old patient with PIMS-TS with aseptic meningitis, stroke, and bilateral internal carotid arteries stenosis suggested SARS-CoV-2 associated vasculitis (12). Our case goes beyond, rather suggesting a runaway of inflammation and hypercoagulation, leading to diffuse and progressive vasculitis, multiple strokes, but also cerebral venous thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Children are less frequently infected by SARS-CoV-2 and usually have less severe forms of Covid-19 than adults (5)(6)(7). Regarding pediatric stroke occurrence, a handful of pediatric stroke cases associated with Covid-19 have been reported so far, with stroke attributed to embolic or hemodynamic mechanism (8,9), focal cerebral arteriopathy (FCA) (10,11), or bilateral vasculitis (12).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent

et al. 2021

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Neurologic manifestations associated with Covid-19 are increasingly reported, especially stroke and acute cerebrovascular events. Beyond cardiovascular risk factors associated with age, some young adults without medical or cardiovascular history had stroke as a presenting feature of Covid-19. Suggested stroke mechanisms in this setting are inflammatory storm, subsequent hypercoagulability, and vasculitis. To date, a handful of pediatric stroke cases associated with Covid-19 have been reported, either with a cardioembolic mechanism or a focal cerebral arteriopathy. We report the case of an adolescent who presented with febrile meningism and stupor. Clinical, biological, and radiological features favored the diagnosis of Lemierre syndrome (LS), with Fusobacterium necrophorum infection (sphenoid sinusitis and meningitis) and intracranial vasculitis. The patient had concurrent SARS-CoV-2 infection. Despite medical and surgical antimicrobial treatment, stroke prevention, and venous thrombosis prevention, he presented with severe cerebrovascular complications. Venous thrombosis and stroke were observed, with an extension of intracranial vasculitis, and lead to death. As both F. necrophorum and SARS-CoV-2 enhance inflammation, coagulation, and activate endothelial cells, we discuss how this coinfection may have potentiated and aggravated the usual course of LS. The potentiation by SARS-CoV-2 of vascular and thrombotic effects of a bacterial infection may represent an underreported cerebrovascular injury mechanism in Covid-19 patients. These findings emphasize the variety of mechanisms underlying stroke in this disease. Moreover, in the setting of SARS-CoV-2 pandemic, we discuss in what extent sanitary measures, namely, lockdown and fear to attend medical facilities, may have delayed diagnosis and influenced outcomes. This case also emphasizes the role of clinical assessment and the limits of telemedicine for acute neurological condition diagnosis.

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COVID-19 associated arterial ischaemic stroke and multisystem inflammatory syndrome in children: a case report

Cited by 47 publications

References 18 publications

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

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

Leucocytoclastic vasculitis secondary to COVID-19 infection in a young child

Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent

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