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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.
Insights
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.
Abstract:
Human coronavirus NL63 (HCoV-NL63) is typically associated with mild upper-respiratory infections, but rare neurological manifestations have been reported. These presentations may closely mimic acute vascular or epileptic events in children. We describe an 8-year-old previously healthy girl who developed vomiting followed by ocular deviation, limb tremors, and brief altered consciousness. On arrival, she was afebrile and hemodynamically stable, with right gaze deviation, miosis, and suspected right hemiparesis. Brain computed tomography (CT) and angiography revealed marked left-hemispheric hypoperfusion consistent with a postictal state. A multiplex respiratory viral panel was positive for HCoV-NL63, while cerebrospinal fluid, microbiological, and toxicological studies were unremarkable. Magnetic resonance imaging (MRI) performed 48 hours later demonstrated complete normalization of perfusion. The patient recovered fully without further seizures. This case highlights a temporal association between HCoV-NL63 infection and transient postictal hemispheric hypoperfusion, underscoring the importance of integrating clinical, radiologic, and virologic data to avoid misdiagnosis of stroke in pediatric patients.
