New research has shown that children's brains can be affected by an inflammatory syndrome linked to COVID-19.
Neurologic findings in adult COVID-19 patients were also observed in some children diagnosed with pediatric inflammatory multisystem syndrome (PIMS), a condition that appears to be associated with exposure to the virus.
Researchers discovered new-onset neurological symptoms in four of 27 (14.8 percent) previously healthy children in a PIMS case series, reported by Yael Hacohen of the University College London and Hacohen's colleagues.
The neurological symptoms in all four children included encephalopathy - damage or disease that affects the brain following a change in the way the organ operates - as well as global muscle weakness.
Three of the children had headaches, while two showed brainstem signs of dysarthria - a speech disorder caused by a disturbance of muscular control - and dysphagia - swallowing difficulties. Two children had reduced reflexes, and one child each presented meningism - the clinical syndrome of headache and neck stiffness, often with nausea and vomiting - and cerebellar ataxia, characterised by a lack of coordination and poor balance.
The study included all patients under 18 who presented new-onset neurological symptoms when admitted to a children's hospital in London from March 1 to May 8, and had a confirmed SARS-CoV-2 infection.
Among the 99 cases of multiorgan inflammatory syndrome in children (MIS-C) reported to the New York State Department of Health by May 10, neurological symptoms - mainly headache - presented in 13 percent of patients aged five and younger, and 38 percent of those aged 13 to 20, according to a report by MedPage Today.
A Chinese study has documented neurologic findings in 36.4 percent of adult patients. Common symptoms include dizziness and headache but all impaired consciousness, ataxia and seizures, MedPage Today reports.
The London study is believed to be the first to describe brain imaging in such children. Neuroimaging showed signal changes in the splenium of the corpus callosum (SCC) region of the brain in all four PIMS patients presenting neurological symptoms, with three showing lesions associated with restricted diffusion.
A transient lesion in the SCC has also been reported in children with Kawasaki disease, a condition known to often overlap with PIMS or MIS-C.
While the results of the imaging have been observed with other viral infections, "clinicians should be adding SARS-CoV-2 to their differential diagnosis for children presenting with new neurologic symptoms and this imaging finding while still exploring other possible causes," Hacohen and her team said.
"Because respiratory symptoms were uncommon in this cohort and, when present, were mild and easily missed, and because reports are growing of children carrying COVID-19 infection without symptoms (with this condition likely presenting late), SARS-CoV-2 should also be considered in pediatric patients presenting with primary neurologic symptoms without systemic involvement."
Dr Kevin Friedman, who has treated PIMS cases at Boston Children's Hospital, said it remains unclear what - if any - medium and long-term implications are associated with the neurologic findings.
"Most patients are returning to normal mental status and having resolution of headache fairly quickly after treatment, but long-term follow-up will be needed to see if there are ongoing implications," he said, as reported by MedPage Today.
The researchers have called for further surveillance of the children.
"The phenotype of our cohort raises the possibility of a virus-specific immunological syndrome," the researchers said.
"A plausible mechanism would be exposure of the immune system to new CNS [central nervous system] antigens as a result of blood-brain barrier damage from SARS-CoV-2, which causes endotheliopathy and leads to an immune-directed attack on the CNS."
The research was reported in JAMA Neurology on July 1.
