New Neuroimaging Study Shows Massive Neurological Effects On Children Infected With COVID-19
According to a new study led by scientist from the University of Manchester –UK, previously healthy children infected with COVID-19 can develop severe neurological complications.
The CNS manifestations of COVID-19 in children have primarily been described in case reports, which limit the ability to appreciate the full spectrum of the disease in pediatric patients.
This study was aimed to identify enough cases that could be evaluated in aggregate to better understand the neuroimaging manifestations of COVID-19 in the pediatric population.
An international call for cases of children with encephalopathy related to SARS-CoV-2 infection and abnormal neuroimaging findings was made. Clinical history and associated plasma and cerebrospinal fluid data were requested. These data were reviewed by a central neuroradiology panel, a child neurologist, and a pediatric infectious diseases expert.
The children were then categorized on the basis of their time of probable 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, were remotely reviewed by a central panel of five paediatric neuroradiologists and a consensus opinion obtained on the imaging findings.
A total of thirty-eight children from eight countries were found to be suffering from brain and/or spinal cord abnormalities.
All the children, who had MRI scans, presented with symptoms including fever, reduced consciousness, problems moving their arms and legs and cognitive dysfunction.
It was found that most of the children (32) had either recovered (26) or were on their way to recovery (6). Eight did not display the respiratory symptoms commonly seen in patients with the virus. Four died from coinfections such as TB and MRSA after COVID-19 had made them more susceptible. Two of the children had paralysis after the virus had affected their spinal cord.
This is to date the largest study of children who's central nervous system has been either directly or indirectly affected by COVID-19.
The study was funded by the American Society of Pediatric Neuroradiology
The study findings were published in the peer reviewed journal: Lancet Child and Adolescent Health.
Although the study is not able to identify the incidence of neurological problems in children with the SARS-CoV-2 coronavirus, the team expected the number to be low.
Professor Dr Stavros Stivaros, pediatric neuroradiologist and director of imaging at The university of Manchester was joint senior author on the study.
Professor Stivaros told Thailand Medical News
, "It's clear from the number of children we have seen with COVID-19, that neurological complications are rare. However it is importance to recognize that COVID-19 could be a possible diagnosis, even if these children are not displaying the viru
s's classic respiratory symptoms. So we hope our study will alert hospital doctors and A & E staff looking after children to the fact COVID-19 should be considered as one of the factors that can cause that brain and spinal cord dysfunction. We have long known that different viruses can impact on the brain and spine, but until this study, we couldn't really say for sure that COVID-19, though rare, could also have this effect."
It was found that of the 38 children with COVID-19 scanned, a group of 12 children presented with respiratory problems caused by the virus with four of these children dying as a result of co-infections. One remained on a ventilator as a result of spinal injury six months after their presentation.
Importantly in a second group, eight children presented with neurological problems but displayed none of the classic symptoms of COVID-19 such as difficulty breathing or loss of taste or smell. Sadly one of these children remains on inpatient on a ventilator also six months after presentation.
However in a third group, 11 children developed a developed a delayed i
nflammatory response to COVID, known as multi-system inflammatory syndrome. And in a final fourth group, seven children had neurological symptoms and abnormal brain and spine imaging but could not be categorized into the other three groups.
"It's important to stress that most children with COVID related neurological illness will get better, but nevertheless it can rarely occur in previously healthy children. A small number of these previously healthy children will die from either directly from COVID-19 or from of their increased sensitivity to other infections and some can get neurological complications from a delayed response to their COVID-19 infection. We also suspect that children who were neurologically impaired through COVID-19 earlier in the pandemic might not have been identified. That could be explained by an absence of available PCR testing or because the atypical or delayed symptoms shown by children were not immediately identified as being COVID-19 related," commented Professor Stivaros.
From the total of the 111 respondents to the American Society of Pediatric Neuroradiology international call for COVID-19 related cases, 80 cases were submitted for review with 42 either being excluded or being withdrawn leaving 38 children reported in the study. And of the 38 children with neurological disease related to SARS-CoV-2 infection 13 came from France, eight from the UK, five from the U.S., four from Brazil, four from Argentina, two from India, one from Peru, and one from Saudi Arabia.
The study team concluded, “This is the largest study to date of CNS imaging manifestations of SARS-CoV-2 infection in children. Mild to severe COVID-19 occurred in healthy children without pre-existing conditions. Outcomes were usually favourable but fatalities and severe residua were also observed. Consistent disease patterns emerged, of which ADEM-like abnormalities of the brain and spinal cord and neuritis were the most common. Cranial nerve enhancement was found to occur without correlative cranial nerve deficits. Cerebrovascular manifestations were less frequently encountered in children compared with SARS-CoV-2 CNS complications reported in adults. Vascular complications were seen most often in the setting of comorbid conditions and consisted of regional and small infarcts, arteritis, and thrombosis. Fulminant atypical co-infections occurred in previously healthy children with acute symptomatic SARS-CoV-2 infections and were fatal in all instances. Finally, in children with MIS-C, the most common findings were splenial lesions and myositis of the neck and face.”
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