Nonvascular Nervous System Complications in Pediatric Patients with COVID-19 Infection

Abstract

Coronavirus disease (COVID-19) is caused by a novel severe acute respiratory syndrome coronavirus 2 virus which primarily targets the lungs. However, the central nervous system (CNS) and peripheral nervous system involvement due to COVID-19, however, has been reported as early as the cases of respiratory system involvement. In addition, there have been many reports describing neuroimaging features of COVID-19, but data beyond case studies in the pediatric population are still limited, indicating limited CNS involvement. The CNS involvement and complications include, but are not limited to, encephalopathy, meningoencephalitis, ischemic stroke, venous sinus thrombosis, acute necrotizing encephalopathy, acute disseminated encephalomyelitis, posterior reversible encephalopathy syndrome, acute cerebellitis, acute hemorrhagic myelitis, and Guillain–Barré syndrome. In this manuscript, we will discuss the imaging characteristics of some of these entities with a known diagnosis of COVID-19.

Keywords

COVID-19 - central nervous system - peripheral nervous system

Publication History

Received: 01 June 2022

Accepted: 01 June 2022

Article published online:
24 August 2022

• References

• 1 Helms J, Kremer S, Merdji H. et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med 2020; 382 (23) 2268-2270
• 2 Moriguchi T, Harii N, Goto J. et al. A first case of meningitis/encephalitis associated with SARS-coronavirus-2. Int J Infect Dis 2020; 94: 55-58
• 3 Beyrouti R, Adams ME, Benjamin L. et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry 2020; 91 (08) 889-891
• 4 Beslow LA, Linds AB, Fox CK. et al; International Pediatric Stroke Study Group. Pediatric ischemic stroke: an infrequent complication of SARS-CoV-2. Ann Neurol 2021; 89 (04) 657-665
• 5 Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. COVID-19-associated acute hemorrhagic necrotizing encephalopathy: imaging features. Radiology 2020; 296 (02) E119-E120
• 6 Parsons T, Banks S, Bae C, Gelber J, Alahmadi H, Tichauer M. COVID-19-associated acute disseminated encephalomyelitis (ADEM). J Neurol 2020; 267 (10) 2799-2802
• 7 Arslan G, Besci T, Karaca Ö, Aylan Gelen S. Posterior reversible encephalopathy syndrome related to COVID-19 in a child. Pediatr Int (Roma) 2022; 64 (01) e14908
• 8 Korkmazer B, Ozogul M, Hikmat E. et al. Posterior reversible encephalopathy syndrome in a pediatric COVID-19 patient. Pediatr Infect Dis J 2021; 40 (06) e240-e242
• 9 Sotgiu S, Uzzau S, Pippia A, Carta A, Antonucci R. Expanding the spectrum of acute cerebellitis due to SARS-Cov-2. Pediatr Neurol 2021; 121: 1-2
• 10 Maghrabi Y, Baeesa SS. Acute hemorrhagic myelitis in an adolescent with COVID-19: a case report and review of literature. Cureus 2021; 13 (12) e20553
• 11 Toscano G, Palmerini F, Ravaglia S. et al. Guillain-Barré syndrome associated with SARS-CoV-2. N Engl J Med 2020; 382 (26) 2574-2576
• 12 Bodro M, Compta Y, Sanchez-Valle R. Presentations and mechanisms of CNS disorders related to COVID-19. Neurol Neuroimmunol Neuroinflamm 2021; 8 (01) e923
• 13 Lindan CE, Mankad K, Ram D, Kociolek LK, Silvera VM, Boddaert N. et al. Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study. Lancet Child Adolesc Health 2021; 5 (03) 167-177
• 14 Sarbu N, Shih RY, Jones RV, Horkayne-Szakaly I, Oleaga L, Smirniotopoulos JG. White matter diseases with radiologic-pathologic correlation. Radiographics 2016; 36 (05) 1426-1447
• 15 Varadan B, Shankar A, Rajakumar A. et al. Acute hemorrhagic leukoencephalitis in a COVID-19 patient-a case report with literature review. Neuroradiology 2021; 63 (05) 653-661
• 16 Grzonka P, Scholz MC, De Marchis GM. et al. Acute hemorrhagic leukoencephalitis: a case and systematic review of the literature. Front Neurol 2020; 11: 899
• 17 Atherton DS, Perez SR, Gundacker ND, Franco R, Han X. Acute disseminated encephalomyelitis presenting as a brainstem encephalitis. Clin Neurol Neurosurg 2016; 143: 76-79
• 18 Fink EL, Robertson CL, Wainwright MS. et al; Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) Investigators. Prevalence and risk factors of neurologic manifestations in hospitalized children diagnosed with acute SARS-CoV-2 or MIS-C. Pediatr Neurol 2022; 128: 33-44
• 19 Agarwal S, Conway J, Nguyen V. et al. Serial imaging of virus-associated necrotizing disseminated acute leukoencephalopathy (VANDAL) in COVID-19. AJNR Am J Neuroradiol 2021; 42 (02) 279-284
• 20 de Miranda Henriques-Souza AM, de Melo ACMG, de Aguiar Coelho Silva Madeiro B, Freitas LF, Sampaio Rocha-Filho PA, Gonçalves FG. Acute disseminated encephalomyelitis in a COVID-19 pediatric patient. Neuroradiology 2021; 63 (01) 141-145
• 21 Akçay N, Bektaş G, Menentoğlu ME. et al. COVID-19-associated acute disseminated encephalomyelitis-like disease in 2 children. Pediatr Infect Dis J 2021; 40 (11) e445-e450
• 22 Palabiyik F, Akcay N, Sevketoglu E, Hatipoglu N, Sari EE, Inci E. Imaging of multisystem inflammatory disease in children (MIS-C) associated with COVID-19. Acad Radiol 2021; 28 (09) 1200-1208
• 23 Lindan CE, Mankad K, Ram D. et al; ASPNR PECOBIG Collaborator Group. Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study. Lancet Child Adolesc Health 2021; 5 (03) 167-177
• 24 Siracusa L, Cascio A, Giordano S. et al. Neurological complications in pediatric patients with SARS-CoV-2 infection: a systematic review of the literature. Ital J Pediatr 2021; 47 (01) 123
• 25 Manzano GS, McEntire CRS, Martinez-Lage M, Mateen FJ, Hutto SK. Acute disseminated encephalomyelitis and acute hemorrhagic leukoencephalitis following COVID-19: systematic review and meta-synthesis. Neurol Neuroimmunol Neuroinflamm 2021; 8 (06) e1080
• 26 McLendon LA, Rao CK, Da Hora CC, Islamovic F, Galan FN. Post-COVID-19 acute disseminated Encephalomyelitis in a 17-month-old. Pediatrics 2021; 147 (06) e2020049678
• 27 Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol 2015; 14 (09) 914-925
• 28 Lee VH, Wijdicks EF, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008; 65 (02) 205-210
• 29 Strandgaard S, Olesen J, Skinhoj E, Lassen NA. Autoregulation of brain circulation in severe arterial hypertension. BMJ 1973; 1 (5852): 507-510
• 30 Bartynski WS. Posterior reversible encephalopathy syndrome, part 2: controversies surrounding pathophysiology of vasogenic edema. AJNR Am J Neuroradiol 2008; 29 (06) 1043-1049
• 31 Colombo A, Martinelli Boneschi F, Beretta S. et al. Posterior reversible encephalopathy syndrome and COVID-19: a series of 6 cases from Lombardy, Italy. eNeurologicalSci 2020; 22: 100306
• 32 Iftikhar S, Rehman AU, Ameer MZ. et al. The association of posterior reversible encephalopathy syndrome with COVID-19: a systematic review. Ann Med Surg (Lond) 2021; 72: 103080
• 33 Hu B, Huang S, Yin L. The cytokine storm and COVID-19. J Med Virol 2021; 93 (01) 250-256
• 34 Kontzialis M, Soares BP, Huisman TAGM. Lesions in the splenium of the corpus callosum on MRI in children: a review. J Neuroimaging 2017; 27 (06) 549-561
• 35 Bektaş G, Akçay N, Boydağ K, Şevketoğlu E. Reversible splenial lesion syndrome associated with SARS-CoV-2 infection in two children. Brain Dev 2021; 43 (02) 230-233
• 36 Edjlali M, Le Gal A, Louvet M. et al; Garches COVID-19 Collaborative Group. Teaching NeuroImages: cytotoxic lesions of the corpus callosum in encephalopathic patients with COVID-19. Neurology 2020; 95 (22) 1021-1022
• 37 DE Oliveira FAA, DE Melo TFB, Rocha-Filho PAS. FAA DEO. Transient lesion in the splenium of the corpus callosum associated with COVID-19. Arq Neuropsiquiatr 2020; 78 (11) 738
• 38 Forestier G, de Beaurepaire I, Bornet G, Boulouis G. Cytotoxic lesion of the corpus callosum as presenting neuroradiological manifestation of COVID-2019 infection. J Neurol 2021; 268 (05) 1595-1597
• 39 Caress JB, Castoro RJ, Simmons Z. et al. COVID-19-associated Guillain-Barré syndrome: the early pandemic experience. Muscle Nerve 2020; 62 (04) 485-491
• 40 Jacobs BC, Rothbarth PH, van der Meché FG. et al. The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study. Neurology 1998; 51 (04) 1110-1115
• 41 Haber P, DeStefano F, Angulo FJ. et al. Guillain-Barré syndrome following influenza vaccination. JAMA 2004; 292 (20) 2478-2481
• 42 Akçay N, Menentoğlu ME, Bektaş G, Şevketoğlu E. Axonal Guillain-Barre syndrome associated with SARS-CoV-2 infection in a child. J Med Virol 2021; 93 (09) 5599-5602
• 43 McKean N, Chircop C. Guillain-Barré syndrome after COVID-19 vaccination. BMJ Case Rep 2021; 14 (07) e244125
• 44 Sadeghizadeh A, Pourmoghaddas Z, Zandifar A. et al. Reversible cerebral vasoconstriction syndrome and multisystem inflammatory syndrome in children with COVID-19. Pediatr Neurol 2022; 129: 1-6