Abstract
Background
The manifestations of central nervous system (CNS) COVID-19 infection in children are primarily described in case reports that limit the ability to appreciate the full spectrum of disease in pediatric patients. The purpose of this study was to identify enough cases that could be evaluated in aggregate, in order to better understand the neuroimaging manifestations of COVID-19 in the pediatric population.
Methods
An international call for cases of children with encephalopathy related to SARS-CoV-2 infection and abnormal neuroimaging yielded 80 children with CNS abnormality on imaging. Clinical history and associated plasma/cerebrospinal fluid data was requested (Table 2, Webappendix page 1). This data was reviewed by a central neuroradiology panel, a child neurologist and a paediatric infectious diseases expert. The children were categorised on the basis of their time of likely exposure to SARS-CoV-2. In addition cases were excluded when a direct link to SARS-CoV-2 infection could not be established or an established alternate diagnostic cause could be hypothesized. The accepted referral centre imaging data, from ten countries, was remotely reviewed by a central panel of five paediatric neuroradiologists and a consensus opinion obtained on the imaging findings.
Findings
In total 38 children with neurological disease related to SARS-CoV-2 infection were identified. The cases represented contributions (number in parentheses) from France (13), United Kingdom (8), United States of America (5), Brazil (4), Argentina (4), India (2), Peru (1) and Saudi Arabia (1). Recurring patterns of disease were identified with neuroimaging abnormalities ranging from mild to severe. The most common imaging patterns encountered were post-infectious immune-mediated ADEM-like changes, myelitis or neural enhancement. We found that cranial nerve enhancement may occur in the absence of corresponding neurological symptoms. Splenial lesions and myositis were predominantly observed in patients with MIS-C. Unlike adults, cerebrovascular complications in children were less common. Significant pre-existing conditions were absent and the majority of children had a favorable outcome. However, this study also revealed development of fatal atypical CNS co-infections in 4 previously healthy children infected by SARS-CoV-2.
Interpretation
Acute and delayed-phase SARS-CoV-2-related CNS abnormalities are seen in children. Recurring patterns of disease and atypical neuroimaging manifestations can be found and should be recognized for SARS-CoV-2 infection as a potential underlying etiological factor.
The manifestations of central nervous system (CNS) COVID-19 infection in children are primarily described in case reports that limit the ability to appreciate the full spectrum of disease in pediatric patients. The purpose of this study was to identify enough cases that could be evaluated in aggregate, in order to better understand the neuroimaging manifestations of COVID-19 in the pediatric population.
Methods
An international call for cases of children with encephalopathy related to SARS-CoV-2 infection and abnormal neuroimaging yielded 80 children with CNS abnormality on imaging. Clinical history and associated plasma/cerebrospinal fluid data was requested (Table 2, Webappendix page 1). This data was reviewed by a central neuroradiology panel, a child neurologist and a paediatric infectious diseases expert. The children were categorised on the basis of their time of likely exposure to SARS-CoV-2. In addition cases were excluded when a direct link to SARS-CoV-2 infection could not be established or an established alternate diagnostic cause could be hypothesized. The accepted referral centre imaging data, from ten countries, was remotely reviewed by a central panel of five paediatric neuroradiologists and a consensus opinion obtained on the imaging findings.
Findings
In total 38 children with neurological disease related to SARS-CoV-2 infection were identified. The cases represented contributions (number in parentheses) from France (13), United Kingdom (8), United States of America (5), Brazil (4), Argentina (4), India (2), Peru (1) and Saudi Arabia (1). Recurring patterns of disease were identified with neuroimaging abnormalities ranging from mild to severe. The most common imaging patterns encountered were post-infectious immune-mediated ADEM-like changes, myelitis or neural enhancement. We found that cranial nerve enhancement may occur in the absence of corresponding neurological symptoms. Splenial lesions and myositis were predominantly observed in patients with MIS-C. Unlike adults, cerebrovascular complications in children were less common. Significant pre-existing conditions were absent and the majority of children had a favorable outcome. However, this study also revealed development of fatal atypical CNS co-infections in 4 previously healthy children infected by SARS-CoV-2.
Interpretation
Acute and delayed-phase SARS-CoV-2-related CNS abnormalities are seen in children. Recurring patterns of disease and atypical neuroimaging manifestations can be found and should be recognized for SARS-CoV-2 infection as a potential underlying etiological factor.
| Original language | English |
|---|---|
| Journal | Lancet Child and Adolescent Health |
| Publication status | Accepted/In press - 12 Nov 2020 |
