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

Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome

“…In the pediatric literature consisting of case reports and 2 international case series, ischemic stroke type has been reported in 18 children with COVID-19 with stroke mechanisms similar to those observed in our study. 44,[66][67][68][69] Acute ischemic stroke in hospitalized adults with COVID-19 is not uncommon. 8,33,70 We also describe global cerebral involvement in 15 patients (8 with MIS-C) with severe encephalopathy, 8 patients with acute CNS infection (encephalitis, aseptic meningitis) or postinfectious, central demyelination (ADEM), and 4 patients with acute fulminant cerebral edema.…”

“…We identified 5 previously healthy patients who presented with severe encephalopathy, focal neurologic deficits, and visual hallucinations (4 of 5 cases) and had diffuse abnormal T2 hyperintensities and reduced diffusivity involving the white matter and genu or splenium of the corpus callosum on MRI. These imaging features have been ascribed to COVID-19 in adults 50, 71 and in children with MIS-C. 44,51,52 Cytotoxic lesions in the corpus callosum are thought to be associated with increased numbers of glutamate and cytokine receptors in the corpus callosum, particularly the splenium. 44,72,73 Similar to the range of outcomes in 1 small adult case series, 50 3 patients had unfavorable outcomes (1 died and 2 were discharged with new deficits including cognitive impairment and painful neuropathy requiring gabapentin).…”

“…These imaging features have been ascribed to COVID-19 in adults 50, 71 and in children with MIS-C. 44,51,52 Cytotoxic lesions in the corpus callosum are thought to be associated with increased numbers of glutamate and cytokine receptors in the corpus callosum, particularly the splenium. 44,72,73 Similar to the range of outcomes in 1 small adult case series, 50 3 patients had unfavorable outcomes (1 died and 2 were discharged with new deficits including cognitive impairment and painful neuropathy requiring gabapentin). Of those with acute CNS infections/ADEM, 7 patients in our study could be confirmed as having probable acute CNS infection using published case definitions.…”

“…48,49 Case reports and small case series also support a link between meningoencephalitis and COVID-19 in adults [74][75][76] and children. 44,[77][78][79] There were 4 cases of previously healthy children who developed acute fulminant cerebral edema directly associated with COVID-19 or MIS-C, and 3 died. Acute fulminant cerebral edema has been previously reported in a child with COVID-19 80 and is a recognized phenotype with high mortality in adults 81,82 and children 44,83 associated with other viral causes.…”

“…[36][37][38][39][40] The frequency of neurologic involvement in children hospitalized with acute COVID-19 is unclear with 150 of 4190 patients reported across 9 international case series. [41][42][43][44][45][46] Using the Overcoming COVID-19 US public health surveillance registry of children and adolescents hospitalized with COVID-19-related complications, 36 we aimed to describe the type and severity of neurologic involvement and documented hospital outcomes.…”