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

Abstract

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.

A Systematic Review of Severe Neurological Manifestations in Pediatric Patients with Coexisting SARS-CoV-2 Infection

“…MRI findings related to MIS-C were described by Abdel-Mannan et al, 2020, in four children [10]. The pathophysiology of the neurologic complications in MIS-C remains unclear [77]. A multisystem inflammatory syndrome in adults has also been reported [78].…”

Differences and similarities of multisystem inflammatory syndrome in children, Kawasaki disease and macrophage activating syndrome due to systemic juvenile idiopathic arthritis: a comparative study

“…Cardiac involvement is common in MIS-C and KD patients while the nature of cardiac findings is quite different. Myocarditis is more common in patients with MIS-C than patients with KD while CA involvement is more commonly observed in KD compared to MIS-C patients [ 5 , 6 , 16 – 20 , 31 ]. Similar to recent studies, myocarditis was more common while CA involvement was less commonly observed in our MIS-C patients than KD patients.…”

Acute Large Vessel Ischemic Stroke in Patients With COVID-19–Related Multisystem Inflammatory Syndrome

“…In a comprehensive study of MIS-C spanning 53 pediatric health centers across the US, Feldstein et al reported that among adolescents aged 13-20 years, the gastrointestinal, respiratory, and cardiac systems were the most commonly affected at 90%, 87%, and 80%, respectively [ 2 ]. Neurological involvement has been reported in 11-30% of children with MIS-C [ 2 , 3 ]. Commonly reported neurological symptoms include fatigue, generalized weakness, confusion, headache, and loss of sense of taste or smell [ 7 ].…”

“…While MIS-C most commonly presents with gastrointestinal, respiratory, and cardiac involvement, neurological involvement has been reported in 11-30% of patients [ 2 , 3 ]. Because acute ischemic stroke (AIS) is uncommon in pediatric patients, there can be a delay in diagnosis leading to high morbidity and mortality.…”