Neurologic Features Associated With SARS-CoV-2 Infection in Children: A Case Series Report

Sandoval, Francisca; Julio, Katherine; Méndez, Gastón; Valderas, Carolina; Echeverría, Alejandra C; Perinetti, María José; Suarez, N Mario; Barraza, Gonzalo; Piñera, Cecilia; Alarcón, M.; Samaniego, Fernando; Quesada-Rios, Pía; Robles, Carlos Maldonado; Izquierdo, Giannina

doi:10.1177/0883073821989164

Cited by 54 publications

(66 citation statements)

References 47 publications

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“…Additionally, the level of hyperferritinemia identified in our populations and in other MIS‐C studies has been at a much lower degree than what would be required to meet criteria for the HScore, which, along with lack of organomegaly, makes it difficult to meet the HScore criteria ( 15 ). Alternatively, the 2019 MS score likely overestimated CSS in our population, as CNS involvement is one of the largest components of the score and is defined as anything from a headache to seizure, so a vast majority of patients met these criteria ( 16 ). This likely overestimation is seen in the fact that a large proportion of even mild MIS‐C cases were identified as at risk for CSS by the MS score, showing that it does not do well at distinguishing disease severity.…”

Section: Discussionmentioning

confidence: 99%

Performance of Cytokine Storm Syndrome Scoring Systems in Pediatric COVID‐19 and Multisystem Inflammatory Syndrome in Children

Reiff

Cron

2021

ACR Open Rheumatology

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Objective The objective of this study is to evaluate pediatric patients using existing macrophage activation syndrome (MAS) and hemophagocytic lymphohistiocytosis (HLH) scoring systems to determine how these systems identify patients with cytokine storm syndrome (CSS) in the setting of a multisystem inflammatory syndrome in children (MIS‐C) and active coronavirus disease 2019 (COVID‐19) infection. Methods Hospitalized pediatric patients with MIS‐C and active COVID‐19 infection at a single institution were identified. Infectious data, clinical findings, and laboratory values were collected, and patients were stratified by disease severity. Eight historically used scoring systems for MAS, HLH, and CSS were examined in the cohort of patients with MIS‐C and pediatric COVID‐19. Results The HLH‐2004 criteria and HScore did not identify any patients as having CSS on admission, with only one patient with COVID‐19 meeting criteria at peak disease severity. The 2016 systemic juvenile idiopathic arthritis (sJIA)/MAS criteria, ferritin/erythrocyte sedimentation rate (ESR) ratio, and COVID‐19 CSS Quick Score most frequently identified CSS in this population and distinguished between COVID‐19 and MIS‐C hyperinflammation. The 2019 MAS/sJIA (MS) score and the COVID‐19–associated hyperinflammatory syndrome (cHIS) criteria were less likely to identify CSS, as the MS score overestimated CSS and the cHIS resulted in similar scores regardless of severity or disease type. The Caricchio COVID‐Cytokine Storm (COVID‐CS) criteria identified patients with COVID‐19 frequently but was less useful in MIS‐C because of its COVID‐19‐specific criteria. Conclusion MIS‐C and pediatric COVID‐19 result in relatively unique CSSs and patterns of inflammation. Existing scoring systems for CSSs likely do not capture the full breadth of this disease process in MIS‐C and pediatric COVID‐19.

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Section: Discussionmentioning

confidence: 99%

Performance of Cytokine Storm Syndrome Scoring Systems in Pediatric COVID‐19 and Multisystem Inflammatory Syndrome in Children

Reiff

Cron

2021

ACR Open Rheumatology

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“…In the broader published pediatric literature, neurological manifestations such as smell/taste disorders, headache, seizures, and stroke appear to predominate in acute COVID-19, whereas headache, encephalopathy, and MRI changes suggesting neuroinflammation predominate in MIS-C. Examples of neurological manifestations in children reported to date are summarized by clinical phenotype in Table 1 [ 60 , 61 , 62 ▪▪ , 63 ▪ , 64 , 65 ▪ , 66 , 67 ▪ , 68 – 75 , 76 ▪ , 77 , 78 ▪ , 79 , 80 ▪▪ ]. As these studies represent different pediatric cohorts (e.g.…”

Section: Neurological Manifestations Of Severe Acute Respiratory Syndrome Coronavirus-2mentioning

confidence: 99%

Worldwide epidemiology of neuro-coronavirus disease in children: lessons for the next pandemic

Alcamo

McGuire

Kanthimathinathan

et al. 2021

Current Opinion in Pediatrics

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Purpose of review The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has overwhelmed the global community, negatively impacting patient health and research efforts; associated neurological manifestations are a significant cause of morbidity. This review outlines the worldwide epidemiology of neurologic manifestations of different SARS-CoV-2 clinical pediatric phenotypes, including acute coronavirus disease 2019 (COVID-19), multisystem inflammatory syndrome in children (MIS-C) and postacute sequelae of COVID-19 (PASC). We discuss strategies to develop adaptive global research platforms for future investigation into emerging pediatric neurologic conditions. Recent findings Multicenter, multinational studies show that neurological manifestations of acute COVID-19, such as smell/taste disorders, headache, and stroke, are common in hospitalized adults (82%) and children (22%), associated with increased mortality in adults. Neurological manifestations of MIS-C are reported in up to 20% of children, including headache, irritability, and encephalopathy. Data on PASC are emerging and include fatigue, cognitive changes, and headache. Reports of neurological manifestations in each phenotype are limited by lack of pediatric-informed case definitions, common data elements, and resources. Summary Coordinated, well resourced, multinational investigation into SARS-CoV-2-related neurological manifestations in children is critical to rapid identification of global and region-specific risk factors, and developing treatment and mitigation strategies for the current pandemic and future health neurologic emergencies.

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“…One study conducted in Chile showed 77.7% of patients who had significant improvement in neurologic manifestations of COVID-19/ MIS-C, with persistent dysguesia noted in 2/13 patients and another case series showed 55% of MIS-C patients clinically normal at the time of discharge with minimal residual symptoms. 8 , 12 In contrast, another multicenter study showed that while most patients had transient neurologic symptoms that resolved by the time of discharge, 12% of patients had severe neurologic morbidity with majority of these patients having death or neurologic disability at the time of discharge, 9 which highlights the wide range of outcomes following COVID-19 infection. Several case series and a recent multicenter study have demonstrated the heterogeneity of neurologic clinical and radiographic manifestations of MIS-C, and our case is an additional example of that.…”

Section: Discussionmentioning

confidence: 99%

Report of a Child With Febrile Status Epilepticus and Post-COVID Multi-System Inflammatory Syndrome

Appleberry

Begezda

Cheung

et al. 2021

Child Neurology Open

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Multi-system Inflammatory Syndrome in Children (MIS-C) is a post infectious inflammatory syndrome following COVID infection. Previous case series have demonstrated that CNS involvement is less common and presents heterogeneously. The following case describes an infant with an initial presentation of refractory febrile status epilepticus. Genetic testing later showed multiple variants of uncertain significance. The patient met clinical criteria for MIS-C and had a markedly abnormal brain MRI with bilateral diffuse restricted diffusion (anterior > posterior). Clinically, the patient improved with pulse steroids and IVIg. This case highlights the importance of maintaining MIS-C in the differential as a trigger of Febrile Infection Related Epilepsy Syndrome (FIRES) with multi-organ involvement presenting 2-4 weeks after infectious symptoms and COVID exposure.

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Neurologic Features Associated With SARS-CoV-2 Infection in Children: A Case Series Report

Cited by 54 publications

References 47 publications

Performance of Cytokine Storm Syndrome Scoring Systems in Pediatric COVID‐19 and Multisystem Inflammatory Syndrome in Children

Performance of Cytokine Storm Syndrome Scoring Systems in Pediatric COVID‐19 and Multisystem Inflammatory Syndrome in Children

Worldwide epidemiology of neuro-coronavirus disease in children: lessons for the next pandemic

Report of a Child With Febrile Status Epilepticus and Post-COVID Multi-System Inflammatory Syndrome

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