Neuroimaging Offers Low Yield in Children Positive for SARS-CoV-2

Abstract

The coronavirus disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome coronavirus disease 2 (SARS CoV-2) most commonly presents with respiratory disease, but neurologic complications are being reported. We aimed to investigate the rate of positive neuroimaging findings in children positive for SARS-CoV-2 referred for neuroimaging between March 18 and September 30, 2020. We found that 10% (n = 2) had acute findings. Our results may suggest that in children, neurologic involvement in COVID-19 is rare, neuroimaging has a low yield in diagnosis, and acute neuroimaging should involve careful risk-benefit analysis.

FIG 1.

A 7-year-old boy with sickle cell disease who presented with dyspnea and chest pain tested positive for SARS-CoV-2. The patient was unresponsive, having desaturations and being intubated. Brain MR imaging showed T2-FLAIR hyperintensity and cortical edema in the occipital lobes, consistent with posterior reversible encephalopathy syndrome, partially resolving on subsequent imaging (A–C, arrows). Note interval evolution of right frontal subarachnoid hemorrhage (D–F, arrows).

FIG 2.

A previously healthy 9-year-old girl who presented with status epilepticus tested positive for SARS-CoV-2. Brain MR imaging showed subtle right hippocampal T2-FLAIR signal alteration with corresponding edema (arrows) on initial (upper row) and follow-up (lower row) imaging.