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Transient Postictal Hemispheric Hypoperfusion Associated With Human Coronavirus NL63 in a Child
Mariana Martins1, Ana Filipa Mouro2, Magalys Pereira3
1Department of Pediatrics, Unidade Local de Saúde São João, Porto, Portugal.
Clinical Pediatrics
|April 13, 2026
Summary
Human coronavirus NL63 (HCoV-NL63) infection can cause rare neurological symptoms in children, mimicking stroke. This case shows HCoV-NL63 linked to temporary brain hypoperfusion, highlighting the need for careful diagnosis.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Human coronavirus NL63 (HCoV-NL63) typically causes mild respiratory illness.
- Neurological complications of HCoV-NL63 are rare but can mimic serious acute events in children.
- Distinguishing viral-induced neurological events from stroke or seizures is critical for appropriate management.
Purpose of the Study:
- To report a case of HCoV-NL63 infection presenting with neurological manifestations.
- To highlight the association between HCoV-NL63 and transient hemispheric hypoperfusion.
- To emphasize the importance of integrated diagnostic approaches in pediatric neurological emergencies.
Main Methods:
- Case report of an 8-year-old girl with acute neurological symptoms.
- Clinical evaluation, neuroimaging (CT, angiography, MRI), and multiplex respiratory viral panel.
- Cerebrospinal fluid, microbiological, and toxicological analyses.
Main Results:
- The patient presented with vomiting, altered consciousness, and focal neurological signs.
- Brain imaging revealed left-hemispheric hypoperfusion, initially suggestive of a postictal state.
- HCoV-NL63 was detected; other tests were negative. MRI showed perfusion normalization within 48 hours.
Conclusions:
- HCoV-NL63 infection was temporally associated with transient postictal hemispheric hypoperfusion in this pediatric case.
- This presentation underscores the potential for HCoV-NL63 to cause neurological symptoms mimicking stroke.
- Integrated clinical, radiologic, and virologic assessment is crucial to prevent misdiagnosis in children.
