Neurological Manifestations of Children With COVID-19

In a small case series, children with confirmed coronavirus disease 2019 (COVID-19) presented with new neurological symptoms associated with lesions of the splenium of the corpus collosum (SCC), suggesting neurological involvement in COVID-19 pediatric multisystem inflammatory syndrome. Findings from this case series were published in JAMA Neurology.

The case series included 4 children <18 years of age who presented to a children’s hospital in London, United Kingdom, between March 1 and May 8, 2020 with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by a quantitative reverse transcription polymerase chain reaction (PCR) assay by nasopharyngeal swab or a positive test result for IgG antibodies against SARS-CoV-2 in serum. All patients presented with new neurological symptoms, including encephalopathy, headaches, brainstem and cerebellar signs, muscle weakness, and reduced reflexes.

Electronic patient records were retrospectively reviewed to obtain data on demographics, comorbidities, neurological symptoms, neurological investigations, treatments, and outcomes.

Intensive care unit admission was required for all 4 patients in order to treat COVID-19 pediatric multisystem inflammatory syndrome. Magnetic resonance imaging of the brain revealed signal changes in the SCC of all patients. Cerebrospinal fluid samples were acellular with normal glucose and protein levels in the 2 patients who had lumbar punctures. In these patients, the investigators also observed negative results for oligoclonal bands, bacterial cultures, and viral and bacterial PCR, including negative results for SARS-CoV-2 PCR.

In all patients, test results were negative for N methyl-D-aspartate receptor, myelin oligodendrocyte glycoprotein, and aquaporin-4 autoantibodies. A mild excess of slow activity was observed in 3 patients who underwent electroencephalography.

Conversely, mild myopathic and neuropathic changes were observed in 3 patients who underwent nerve conduction studies as well as electromyography. A total of 3 patients were treated with immunomodulatory therapies as part of a management approach to COVID-19 pediatric multisystem inflammatory syndrome. No patients received antiviral therapy.

Full recovery and hospital discharge were reported for 2 patients after a median follow-up period of 18 (range, 11-32) days. All patients experienced neurological improvement. At time of publication, the remaining 2 patients in this case series had been discharged from the ICU and remained inpatients. Both of these patients were wheelchair bound at time of data publication, but both were experiencing clinical improvement.

The investigators recommend that “clinicians should be adding SARS-CoV-2 to their differential diagnosis for children presenting with new neurologic symptoms” with the neurological imaging findings identified in this case series “while still exploring other possible causes.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Abdel-Mannan O, Eyre M, Löbel U, et al. Neurologic and radiographic findings associated with COVID-19 infection in children [published online July 1, 2020]. JAMA Neurol. doi:10.1001/jamaneurol.2020.2687