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Miller Fischer and posterior reversible encephalopathy syndromes post COVID-19 infection
1From the Department of Pediatrics, Collage of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabi.
Insights
This case report details a child who developed Miller Fisher syndrome and posterior reversible encephalopathy syndrome after COVID-19 infection. It highlights rare but serious neurological complications in pediatric COVID-19 cases.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- COVID-19 infection presents with varied clinical symptoms, affecting both symptomatic and asymptomatic individuals.
- Neurological complications of COVID-19 in children are less common but can be severe.
Observation:
- An 11-year-old boy experienced vomiting, headache, blurred vision, dysarthria, dysphagia, respiratory failure, muscle weakness, and unsteadiness.
- The patient had prior exposure to a COVID-19-infected individual.
- Cerebral MRI revealed findings consistent with posterior reversible encephalopathy syndrome (PRES).
Findings:
- A diagnosis of Miller Fisher syndrome (MFS), a variant of Guillain-Barré syndrome, was established.
- Cerebrospinal fluid analysis showed cytoalbuminous dissociation.
- Nerve conduction velocity studies confirmed polyneuropathy, and diaphragmatic fluoroscopy indicated limited movement.
Implications:
- This case underscores the potential for serious neurological sequelae, including MFS and PRES, following COVID-19 in children.
- Clinicians should consider these rare neurological complications in pediatric patients presenting with relevant symptoms post-COVID-19.
- Early recognition and diagnosis of Guillain-Barré syndrome variants are crucial for timely management.
Abstract:
COVID-19 infection displays heterogeneity of clinical manifestations in symptomatic and asymptomatic patients. We report on a child with Miller Fischer syndrome (MFS) and posterior reversible encephalopathy syndrome (PRES) post-COVID-19 infection. An 11-year-old boy presented with vomiting, headache, blurred vision, dysarthria, dysphagia, respiratory failure, muscle weakness, and unsteadiness. He had been exposed to COVID-19 through an asymptomatic elder brother two months prior to his illness. The MRI brain showed findings consistent with PRES and the diagnosis with Miller Fischer variant of the Guillain-Barré syndrome was made. A cerebrospinal fluid analysis revealed cytoalbuminous dissociation, and a nerve conduction velocity study conclusively showed polyneuropathy. A fluoroscopy of the diaphragms found that there was limited movement in both. Although children seem to be less affected by COVID-19 infection, this report highlights on an important neurological complications that can develop in children and its presence should be taken into consideration when diagnosing different forms of Guillain-Barré.
