Acute Ischemic Stroke in an Infant With COVID-19 Infection and Delayed Diagnosis of Neurofibromatosis Type 1

Acute ischemic stroke is an uncommon presentation in the pediatric population as compared to the elderly population. COVID-19 infection is associated with several neurological manifestations, with ischemic strokes being underrecognized. Cerebrovascular events associated with COVID-19 may be due to systemic inflammation and hypercoagulable state. Neurofibromatosis type 1 (NF1) is an inherited multisystem disorder caused by dominant loss-of-function mutations of the tumor-suppressor gene neurofibromin 1, which is located at 17q11.2.1. NF1 is associated with multiple cerebrovascular abnormalities, including internal carotid artery occlusion. A review of the current literature on manifestations of COVID-19 in the pediatric population, including stroke and seizures, is also provided in this case report. A brief review of the literature on neurofibromatosis and the risk of stroke as well as other clinical manifestations is also included as a part of this case report. This case illustrates the importance of recognizing acute and rare complications of neurofibromatosis. Cerebral vasculopathy is an important but underrecognized complication of NF1. Children with neurofibromatosis and hypertension require a thorough and complete neurologic evaluation. This case describes a young infant with a delayed clinical diagnosis of NF1 who was presented with viral manifestations of COVID-19 infection and was diagnosed with a large middle cerebral artery stroke.