CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2022; 32(04): 510-522
DOI: 10.1055/s-0042-1755250
Original Article

Neurological and Neuroradiological Patterns with COVID-19 Infection in Children: A Single Institutional Study

Sanchi Rastogi
1   Department of Neurology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
2   Department of Radiology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
Shilpa Kulkarni
1   Department of Neurology, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
Vrushabh Gavali
3   Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
› Author Affiliations


Background Varied neurological manifestations in pediatric patients with coronavirus disease 2019 (COVID-19) have been increasingly reported from all across the world in the scientific literature.

Objective We aimed to evaluate pediatric cases with neurological symptoms and neuroimaging findings with COVID-19 infection in our hospital.

Materials and Methods Children from 0 to 12 years with laboratory evidence of COVID-19 infection and acute neurological manifestations within 3 months, who have undergone magnetic resonance imaging (MRI) were included in the study. We categorized them based on neurological findings into four groups: acute encephalitis syndrome (AES), acute flaccid paralysis (AFP), cerebrovascular event/stroke, and miscellaneous consisting of acute seizures without encephalopathy.

Results A total of 19 children with neurological manifestations related to COVID-19 infection were included in the study. AES was the most common neurological syndrome seen in 47.36%, followed by AFP in 26.31% and cardiovascular event/stroke in 21.05%. Seizure was the most common neurological symptoms in 62.15%, followed by encephalopathy in 42.10% and AFP in 26.31%. On neuroimaging, pattern observed were immune-mediated cauda equina nerve roots enhancement in 26.31% or acute disseminated encephalitis in 5.26%, small acute infarcts, hippocampal, and bilateral thalamic signal changes seen in 21.05% each, microhemorrhages and leukoencephalopathy in 15.78%, and coinfection in 5.26%.

Conclusion In our study, seizures and encephalopathy were the most common neurological symptoms with COVID-19 infection. Postinfectious immune-mediated cauda equina nerve root enhancement or acute demyelinating encephalomyelitis–like brain imaging, followed by small acute infarcts and hippocampal/thalamic signal changes were most common imaging patterns. We found overlapping neurological and MRI patterns in many children, suggesting that various pathophysiological mechanisms act individually or synergistically.

Availability of Data and Material

Retrospectively collected from medical record office.

Ethics Approval

Approval taken from our hospital internal ethics committee (IEC) .

Publication History

Article published online:
30 August 2022

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