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Pediatric SARS-CoV-2-Related Diplopia and Mesencephalic Abnormalities
Sara Signa1, Noemi Brolatti1, Chiara Trincianti1
1UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
This case report details a pediatric patient experiencing diplopia and midbrain MRI abnormalities potentially linked to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Treatment with steroids and immunoglobulin therapy led to a full recovery of neurological symptoms.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Neurological complications following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are increasingly reported.
- Pediatric cases of COVID-19-associated neurological symptoms are less common and diverse.
- Mesencephalic involvement represents a rare manifestation of neuroinflammation.
Observation:
- A pediatric patient presented with binocular diplopia and nystagmus.
- Magnetic Resonance Imaging (MRI) revealed mesencephalic tegmentum and periaqueductal region hyperintensity, indicative of an inflammatory midbrain lesion.
- Serological testing confirmed recent SARS-CoV-2 infection, while cerebrospinal fluid analysis for infectious agents and specific autoimmune antibodies was negative.
Findings:
- The patient's clinical presentation and MRI findings suggest a possible immune-mediated central nervous system phenomenon triggered by SARS-CoV-2.
- Treatment with corticosteroids and intravenous immunoglobulin therapy resulted in complete resolution of neurological symptoms.
Implications:
- This case expands the spectrum of known pediatric COVID-19-associated neurological symptoms.
- It highlights the possibility of isolated neurological symptoms as a manifestation of COVID-19 in children.
- Early recognition and treatment may lead to favorable outcomes in similar cases.
