Examining the neurological manifestations of COVID-19

Although coronavirus disease 2019 (COVID-19) is first and foremost a respiratory disease, the past year has shown that the disease can also impact other systems in the body, particularly the cardiovascular system. A report in The Lancet Children & Adolescent Health looks at how the disease shows up in neuroimaging.¹

The researchers put out an international call to find cases of children who had encephalopathy that was linked to a severe case of COVID-19. They asked for the clinical history as well as association cerebrospinal fluid and plasma data for each case as well. Each case was looked at by a child neurologist, pediatric infectious disease expert, and central neuroradiology panel. Any case that did not have a direct link to a COVID-19 infection was excluded from the study.

A total of 38 children with neurological disease linked to COVID-19 were found in France, the United Kingdom, the United States, Brazil, Argentina, India, Peru, and Saudi Arabia. The researchers found recurring patterns of disease and the neuroimaging abnormalities seen ranged from mild to severe. The most common neuroimaging patterns found were postinfectious immune-mediated acute disseminated encephalomyelitis-like changes of the brain (16 patients), neural enhancement (13 patients), and myelitis (8 patients). Children with multisystem inflammatory syndrome in children were the ones most likely to have splenial lesions (7 patients) and myositis (4 patients). Complications in the cerebrovascular system were not as common among children and adults. No significant pre-existing conditions were seen in children and most of them had favorable outcomes. Four children who previously been healthy before COVID-19 developed fatal atypical central nervous system co-infections.

The researchers concluded that central nervous system abnormalities have been seen in children who had COVID-19. They urged further research to get a better understanding of how the disease can impact the central nervous system as well as provide information on how to provide long-term follow-up care.

Reference

1. Lindan C, Mankad K, Ram D, et al. Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study. Lancet Child Adolesc Health. December 15, 2020. Epub ahead of print. doi:10.1016/S2352-4642(20)30362-X