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Post-COVID-19 Multisystem Inflammatory Syndrome-Related Cerebral Infarction in a Pediatric Patient Managed with
Ryan D Morgan1, Reagan A Collins1, Laszlo Nagy1
1Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Insights
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can rarely cause multisystem inflammatory syndrome in children (MIS-C), leading to acute ischemic strokes (AIS). This case highlights successful treatment of a pediatric AIS secondary to SARS-CoV-2 with decompressive craniectomy.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) primarily causes mild symptoms in children, but severe complications like multisystem inflammatory syndrome in children (MIS-C) can occur.
- Rarely, SARS-CoV-2 infection in pediatric patients can lead to acute ischemic strokes (AIS), a serious neurological complication.
Observation:
- A 2-year-old male presented with MIS-C and confirmed SARS-CoV-2 infection, rapidly deteriorating into cardiogenic shock, acute kidney injury, liver dysfunction, and altered mental status.
- Imaging revealed ischemic infarcts in the right middle cerebral artery and bilateral superior cerebellar arteries, confirmed by MRA as occlusions.
Findings:
- The patient underwent emergent decompressive craniectomy due to cerebral edema and rapid neurological decline.
- Successful treatment with decompressive craniectomy led to patient improvement and discharge with moderate disability, which improved with rehabilitation.
Implications:
- This case underscores the potential for SARS-CoV-2 to cause severe neurological events like AIS in children, particularly with conditions like MIS-C.
- Early recognition and aggressive management, including decompressive craniectomy, can be life-saving and improve outcomes in pediatric AIS secondary to viral infections.
Introduction:
Most people who are infected with the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are asymptomatic or present with mild upper respiratory symptoms. This is especially true in the pediatric population; however, rarely, a massive cytokine storm can develop, causing multisystem inflammatory syndrome associated with COVID (MIS-C). Furthermore, children may also suffer from acute ischemic strokes secondary to SARS-CoV-2 infection.
Case Presentation:
Here, we present a 2-year-old male who was admitted to the hospital with MIS-C and evidence of a previous SARS-CoV-2 infection. On postadmission day 2, the patient was in cardiogenic shock, had acute kidney injury, liver dysfunction, and metabolic acidosis. He had concurrent altered mental status, and his computed tomography scan showed ischemic infarcts in the territory of the right middle cerebral artery and superior cerebellar artery bilaterally. Magnetic resonance angiography confirmed occlusion of the right middle cerebral artery and right superior cerebellar artery. He underwent an emergent decompressive craniectomy due to rapid deterioration and cerebral edema. After the procedure, he continued to improve and was discharged with moderate disability that improved during outpatient rehab.
Conclusion:
Though rare in children, SARS-CoV-2 can lead to AIS, especially in the presence of underlying risk factors such as MIS-C and hypercoagulopathy. AIS can be associated with severe mortality and morbidity; however, even in this severe case of AIS, the patient was successfully treated with a decompressive craniectomy.
