Neurologic manifestations in an infant with COVID-19

Abstract

We report the case of a COVID-19-positive 6-week-old who presented with fever, cough, and 2 brief 10-15 seconds episodes of upward gaze and bilateral leg stiffening. CaseA 6-week-old term male infant presented for evaluation after 1 day of cough, fever, and brief episodes of sustained upward gaze associated with bilateral leg stiffening. The initial episode occurred after a diaper change. There was no shaking, breathing change, or pallor during this episode. There was no association with feeding. The infant had 2 siblings with cough and fever at the time of presentation, both diagnosed with streptococcal pharyngitis. On arrival to the emergency department, vital signs were notable for fever of 38.4°C and mild hypertension (114/57). Examination was notable for a mottled appearance and bilateral overlapping of the fourth and fifth toes. The anterior fontanel was soft and nonbulging, and neurologic examination was unremarkable. However, the patient had a witnessed episode of sustained upward gaze associated with bilateral leg stiffening and decreased responsiveness lasting 10 seconds with subsequent return to baseline and no hypoxia or vital signs change.The patient was born at 39 weeks via uncomplicated normal spontaneous vaginal delivery, weighing 3.91 kg. Family history was notable for simple febrile seizures in a developmentally normal sibling. There was no family history of epilepsy.Laboratory data were notable for leukopenia of 5.07 ×10 3 white blood cells (wbcs)/μL (normal 8.14-14.99 × 10 3 ) with a normal differential and elevated procalcitonin of 0.21 ng/mL (normal <0.08 ng/mL). Electrolytes were normal. Respiratory pathogen PCR panel was positive for rhinovirus/enterovirus. SARS-CoV-2 Real-Time Reverse Transcriptase (rRT)-PCR was positive. A chest radiograph was not performed. A lumbar puncture had an unremarkable CSF

RETRACTED: Neurological and neuromuscular manifestations in SARS-CoV-2: Review of Literature and Case Series

“…5 COVID-19 encephalitis may manifest with seizures, as it did in this case report of a 6week old. 8 Patient's EEG showed interictal abnormalities of excessive temporal sharp waves and intermittent delta vertex slowing. One patient in a study of 214 COVID-positive subjects had seizure.…”

“…A case report of a COVID-positive 6 week old with a 3-minute event of tonic stiffening and upgaze showed interictal abnormalities on EEG of excessive temporal sharp waves, intermittent delta vertex slowing. 8 A 24 year-old presented in convulsive status epilepticus, found to have COVID-19. CSF OP was 32 and the rest of the CSF analysis was normal.…”

Central Nervous System Manifestations Associated with COVID-19

“…Dugu et al [ 134 ] reported a 6-week-old COVID-19 case presenting with cough, fever, and two brief episodes (10–15 s) of upward gaze and bilateral leg stiffening. McAbee et al [ 66 ] reported an 11-year-old male COVID-19 case with SE and CSF evidence for encephalitis.…”

COVID‐19: A Global Threat to the Nervous System

“…Confirming this low incidence of seizures, no cases of status epilepticus or new onset seizures were reported in a large cohort of over 304 hospitalized patients with COVID-19 in Hubei Province, China, 12 although there have been isolated case reports describing seizures at presentation in both adult and pediatric patients with COVID-19. 13,14 In the series by Mao and colleagues, 11 the patients were subdivided based on the severity of their pneumonia and pulmonary impairment, and among those with "severe" disease (n = 88) the incidence of CNS symptoms was higher (31%) compared to the non-severe group (21%), although the results were not statistically significant (p = 0.09). Although all the categorized CNS symptoms occurred more frequently in patients with severe disease compared to non-severe disease, only impaired consciousness (15% in severe vs 2% in non-severe, p < 0.001) and acute cerebrovascular disease (5.7% vs 0.8%; p = 0.03) were significantly different between the two groups.…”