Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children

Abstract

IMPORTANCE Neurological manifestations have been reported in adults with coronavirus disease 2019 (COVID-19), which is caused by the highly pathogenic virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVE To report the neurological manifestations of children with COVID-19. DESIGN, SETTING, AND PARTICIPANTS In this case-series study, patients younger than 18 years who presented with SARS-CoV-2 infection and neurological symptoms to Great Ormond Street Hospital for Children (London, UK) between March 1, 2020, and May 8, 2020, were included after infection was confirmed by either a quantitative reverse transcriptionpolymerase chain reaction assay by nasopharyngeal swab or a positive test result for IgG antibodies against SARS-CoV-2 in serum. MAIN OUTCOMES AND MEASURES Clinical and paraclinical features were retrieved from electronic patient records. RESULTS Of the 27 children with COVID-19 pediatric multisystem inflammatory syndrome, 4 patients (14.8%) who were previously healthy had new-onset neurological symptoms. Symptoms included encephalopathy, headaches, brainstem and cerebellar signs, muscle weakness, and reduced reflexes. All 4 patients required intensive care unit admission for the treatment of COVID-19 pediatric multisystem inflammatory syndrome. Splenium signal changes were seen in all 4 patients on magnetic resonance imaging of the brain. In the 2 patients whose cerebrospinal fluid was tested, samples were acellular, with no evidence of infection on polymerase chain reaction or culture (including negative SARS-CoV-2 polymerase chain reaction results) and negative oligoclonal band test results. In all 3 patients who underwent electroencephalography, a mild excess of slow activity was found. Tests for N-methyl-D-aspartate receptor, myelin oligodendrocyte glycoprotein, and aquaporin-4 autoantibodies had negative results in all patients. In all 3 patients who underwent nerve conduction studies and electromyography, mild myopathic and neuropathic changes were seen. Neurological improvement was seen in all patients, with 2 making a complete recovery by the end of the study. CONCLUSIONS AND RELEVANCE In this case-series study, children with COVID-19 presented with new neurological symptoms involving both the central and peripheral nervous systems and splenial changes on imaging, in the absence of respiratory symptoms. Additional research is needed to assess the association of neurological symptoms with immune-mediated changes among children with COVID-19.

Neurological manifestations of coronavirus infections – a systematic review

“…MRI showed signal changes of the splenium in all patients, interpreted as a sign suggestive of an ongoing (para-)infectious process. 75 However, virus was undetectable in CSF from 2/2 sampled children. All patients showed at least some degree of recovery by the end of the study.…”

Documento español de consenso sobre diagnóstico, estabilización y tratamiento del síndrome inflamatorio multisistémico pediátrico vinculado a SARS-CoV-2 (SIM-PedS)

“…La definición de SIM-PedS difiere ligeramente entre distintos organismos sanitarios ( tabla 1 ) 4 , 5 , 6 . Se debe considerar en áreas con alta incidencia actual o reciente de transmisión o enfermedad por SARS-CoV-2 8 . En relación con la EK, muestra semejanza con sus diversos espectros clínicos (EK clásica o completa, EK incompleta, EK con shock-KDSS).…”

“…La radiografía o ecografía torácica se indicarán en caso de sintomatología respiratoria o para localizar dispositivos (tubo endotraqueal o catéter central) 24 . La radiografía de tórax puede mostrar alteraciones en un elevado porcentaje de casos 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 . Se ha descrito imagen neumónica con infiltrados, condensaciones parcheadas, en vidrio esmerilado o patrón intersticial, atelectasias o derrame pleural.…”

“…Su vida media corta, su rapidez de acción y la escasa asociación a sobreinfecciones bacterianas lo postulan como un fármaco seguro. Aunque se presenta en jeringa para administración subcutánea, se ha empleado por vía intravenosa en casos graves 5 , 6 , 7 , 8 , 9 , 10 . Se mantendría durante 5-14 días, según respuesta clínica ( tabla 4 ).…”

Cutaneous manifestations of COVID-19 in children (and adults): A virus that does not discriminate

“… 5 , 6 SARS-CoV-2 enters cells by attaching to angiotensin-converting enzyme-2 (ACE-2) receptors. 4 , 7 , 8 This receptor is found on numerous mucosal sites, 9 , 10 including the endothelium of dermal blood vessels and epithelial cells in eccrine glands, which may account for the cutaneous manifestations of COVID-19. 11 , 12 …”