Reversible splenial lesion syndrome associated with SARS-CoV-2 infection in two children

Bektaş, Gonca; Akçay, Nihal; Boydağ, Kübra; Şevketoğlu, Esra

doi:10.1016/j.braindev.2020.10.002

Cited by 46 publications

(53 citation statements)

References 12 publications

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“…CSF oligoclonal bands were tested in 114 patients who did not have a positive CSF SARS-CoV-2 PCR or positive CSF antibodies to SARS-CoV-2 (103 (90%) who had symptoms that localized to the CNS and 11 (10%) who had symptoms that localized to the PNS) [ 9 , 10 , 19 , 20 , 35 , 36 , 42 , 44 , 45 , 58 , 69 , 74 , 79 , 81 , 101 , 112 , 113 , 116 , 117 , 126 , 127 , 130 , 135 , 136 , 147 , 149 , 152 , 154 , 160 , [168] , [169] , [170] , [171] , 177 , 181 , 182 , [185] , [186] , [187] , [188] , 191 , 194 , 203 , 205 , 207 , 209 , 212 , 213 , 215 , 216 , 218 , 233 , 242 , 245 ]. Of these, 35 (31%) had matched CSF and serum bands [ 9 , 35 , 79 , 112 , 113 , 127 , 147 , 170 , 171 , …”

Section: Resultsmentioning

confidence: 99%

“…A paucity of patients in this cohort had a positive CSF SARS-CoV-2 PCR; of 303 patients who had SARS-CoV-2 PCR tested in the CSF, 17 (6%) patients, all of whom had symptoms that localized to the CNS, had a positive result and an additional 3 (1%) had an indeterminate result [5-10,15,17,22,24,26-38, 43-59,68-71,73,74,76-78,81,84,88,89,95,97,98,101,103,105,108, 109,111,113,116,119,122,123,125,127-129,131,134-144,147-150, 152,154,156,157,161,164,165,169,171,177,178,180-182,184-187, 190,191,193,195-201,203,204,205-207,209,212-216,218-221, 224-227,230,233-238,240-246]. Furthermore, only 14/252 (6%) patients who had direct or indirect evaluation for CSF SARS-CoV-2 antibodies (oligoclonal bands or immunoglobulins), had evidence of intrathecal antibody synthesis [6,9,10,13,19,20,25,31,35,36,[42][43][44][45][46]49,57,58,62,69,74,79,81,98,101,112,113,116,117,119,126,127,130,135,136,141,[147][148][149]152,…”

Section: Discussionmentioning

confidence: 99%

Section: Csf Oligoclonal Bandsmentioning

confidence: 99%

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Cerebrospinal fluid in COVID-19: A systematic review of the literature

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

153

152

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We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. Methods: We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. Results: We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. Conclusion: Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS-CoV-2 are unlikely to be related to direct viral neuroinvasion.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Csf Oligoclonal Bandsmentioning

confidence: 99%

See 1 more Smart Citation

Cerebrospinal fluid in COVID-19: A systematic review of the literature

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

153

152

View full text Add to dashboard Cite

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“…This is characterized by a temporary lesion in the splenium of the corpus callosum, related to encephalitis, seizures, withdrawal of antiepileptic drug, or metabolic disturbances. RESLES with mild encephalitis/encephalopathy and reversible splenial lesion has been defined as a distinct syndrome, associated with various viral infections [ 45 ].…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

The importance of heart and brain imaging in children and adolescents with Multisystem Inflammatory Syndrome in Children (MIS-C)

et al. 2021

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Multisystem Inflammatory Syndrome in Children (MIS-C) recently reported in a minority of children affected by SARS-CoV-2, mimics Kawasaki disease (KD), a medium vessel vasculitis of unknown cause. In contrast to acute COVID-19 infection, which is usually mild in children, 68% of patients with MIS-C will need intensive care unit. Myocarditis and coronary artery ectasia/aneurysm are included between the main cardiovascular complications in MIS-C. Therefore, close clinical assessment is need it both at diagnosis and during follow-up. Echocardiography is the cornerstone modality for myocardial function and coronary artery evaluation in the acute phase. Cardiovascular magnetic resonance (CMR) detects diffuse myocardial inflammation including oedema/fibrosis, myocardial perfusion and coronary arteries anatomy during the convalescence and in adolescents, where echocardiography may provide inadequate images. Brain involvement in MIS-C is less frequent compared to cardiovascular disease. However, it is not unusual and should be monitored by clinical evaluation and brain magnetic resonance (MRI), as we still do not know its effect in brain development. Brain MRI in MIS-C shows T2-hyperintense lesions associated with restricted diffusion and bilateral thalamic lesions. To conclude, MIS-C is a multisystem disease affecting many vital organs, such as heart and brain. Clinical awareness, application of innovative, high technology imaging modalities and advanced treatment protocols including supportive and anti-inflammatory medication will help physicians to prevent the dreadful complications of MIS-C.

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“…The most commonly reported neuroimaging finding in children with COVID-19 and MIS-C was reversible splenial lesion syndrome. [4][5][6][7] Acute disseminated encephalomyelitis, bilateral thalamic cytotoxic lesions, and unilateral focal vasculopathy with acute infarction were other reported neuroimaging findings in pediatric patients with COVID-19. [8][9][10][11] We did not see any of these neuroimaging findings in our patient cohort.…”

Section: Discussionmentioning

confidence: 96%