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COVID-19-Associated Neurological Complications in Children
Shenoy Sangeetha1, Nagabushana Divya1, Sunil Kumar1
1Department of Peadiatrics, Ramaiah Medical College, Bangalore, India.
Insights
Severe neurological symptoms in children after COVID-19 infection are rare but varied. This study details ten pediatric cases, including paralysis, encephalopathy, and thrombosis, highlighting the need for COVID-19 investigation.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neuroimmunology
Background:
- Neurological manifestations of Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) are documented in adults.
- Severe neurological symptoms are infrequently reported in children post-COVID-19 infection or vaccination.
Purpose of the Study:
- To analyze the spectrum of neurological manifestations in children following COVID-19 infection.
- To report a single-center experience with severe neurological symptoms in pediatric COVID-19 cases.
Main Methods:
- Retrospective analysis of case records for patients under 18 years.
- Inclusion criteria: neurological manifestations and confirmed COVID-19 infection or elevated antibodies, excluding other causes.
- Study period: July 2021 to December 2022.
Main Results:
- Ten pediatric cases (ages 1-15) with neurological symptoms and SARS-CoV-2 exposure were identified.
- Presentations included Guillain-Barre syndrome, encephalopathy (Multisystem Inflammatory Syndrome in Children criteria), sagittal sinus thrombosis, leukoencephalopathy, and cerebral mucormycosis.
- Most cases had elevated COVID-19 antibodies; one had active infection.
Conclusions:
- COVID-19 can cause diverse central and peripheral nervous system manifestations in children.
- Investigating for COVID-19 is crucial for pediatric patients presenting with these neurological symptoms during the pandemic.
Objectives:
Neurological manifestations of Severe Acute Respiratory Syndrome coronavirus-2 have been well documented in adults during and after infection with the virus as well as after vaccination. The incidence of severe neurological symptoms among children is very low. This study aimed to analyze the varied neurological manifestations after COVID-19 infection among children and give a report on a single-center experience with these severe neurological symptoms.
Materials & Methods:
Case records of patients less than 18 years admitted between July 2021 to December 2022 with neurological manifestations and COVID-19 infection or with elevated COVID-19 antibodies after exclusion of other etiological diagnosis were analyzed.
Results:
There were 10 cases in the age range of 1-15 years. All the cases had elevated COVID-19 antibodies with history of contact 2-3 weeks prior except one who was positive for COVID-19 infection. Two cases presented with acute ascending paralysis suggestive of Guillain-Barre syndrome. Four cases presented with features of encephalopathy with clinical presentation fulfilling the criteria of Multisystem inflammatory syndrome in children. One case presented with fever and focal seizures with MRI showing sagittal sinus thrombosis, and one presented with fever and altered sensorium with MRI showing leukoencephalopathy. One child had cerebral mucormycosis without any evidence of immunosuppression. There was one child with features of encephalopathy with active COVID-19 infection.
Conclusion:
The varied presentation highlights the central and peripheral nervous system involvement by the virus in the pediatric population. It also emphasizes the need to investigate for COVID-19 in children presenting with these complaints during the pandemic.
