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Review
. 2021 Jan 19:743:135567.
doi: 10.1016/j.neulet.2020.135567. Epub 2020 Dec 19.

Neurological issues in children with COVID-19

Jieru E Lin  1 , Arsenoi Asfour  1 , Taylor B Sewell  2 , Benjamin Hooe  2 , Patrice Pryce  2 , Chelsea Earley  1 , Min Ye Shen  1 , Mallory Kerner-Rossi  1 , Kiran T Thakur  3 , Wendy S Vargas  4 , Wendy G Silver  4 , Andrew S Geneslaw  5
Affiliations
Review

Neurological issues in children with COVID-19

Jieru E Lin et al. Neurosci Lett. .

Abstract

Coronavirus disease 2019 (COVID-19) usually leads to a mild infectious disease course in children, but serious complications may occur in conjunction with both acute infection and associated phenomena such as the multisystem inflammatory syndrome in children (MIS-C). Neurological symptoms, which have been predominantly reported in adults, range from mild headache to seizure, peripheral neuropathy, stroke, demyelinating disorders, and encephalopathy. Similar to respiratory and cardiac manifestations of COVID-19, neurological complications present differently based on age and underlying comorbidities. This review provides a concise overview of the neurological conditions seen in the context of COVID-19, as well as potential mechanisms and long-term implications of COVID-19 in the pediatric population from literature reviews and primary data collected at NewYork-Presbyterian Morgan Stanley Children's Hospital.

Keywords: COVID-19; Multisystem inflammatory syndrome in children (MIS-C); Pediatrics; SARS-CoV-2.

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Figures

Fig. 1
Fig. 1
Hypothesized mechanisms of COVID-19 neurological manifestations. Direct viral effects upon the nervous system, endothelial injury, and downstream effects of para- and post-infectious inflammation, have each been proposed as potential etiologies of the neurological manifestations of Coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may cross into the central nervous system (CNS) via a variety of mechanisms. Endothelial injury may precipitate thrombotic events, as well as release of virus and inflammatory mediators. Cytokine release due to pulmonary or systemic infection may instigate neurological sequelae. And, post-infectious inflammation induced by SARS-CoV-2 may trigger autoimmune phenomena, such as demyelinating disease and encephalopathy. The multisystem inflammatory syndrome in children associated with SARS-CoV-2 may represent a spectrum of para- and post-infectious complications, separate but similar to other inflammatory conditions in children known to sometimes present with neurological sequelae. ESR (erythrocyte sedimentation rate); BNP (B-type natriuretic peptide); IL-6 (interleukin 6).
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