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Review
. 2022 Mar:37:139-154.
doi: 10.1016/j.ejpn.2022.02.003. Epub 2022 Feb 18.

Neurologic manifestations in children with COVID-19 from a tertiary center in Turkey and literature review

Sibel Laçinel Gürlevik  1 , Ceren Günbey  2 , Yasemin Ozsurekci  3 , Pembe Derin Oygar  3 , Selman Kesici  4 , Rahsan Gocmen  5 , Orkun Aydin  6 , Çağrı Temucin  7 , Erennur Tufan  4 , Kıvanc Terzi  4 , Demet Baltu  8 , Tugba Tastemel Ozturk  8 , Ozlem Teksam  6 , Seza Ozen  9 , Kader Karlı Oguz  5 , Ali Bulent Cengiz  3 , Dilek Yalnızoglu  2
Affiliations
Review

Neurologic manifestations in children with COVID-19 from a tertiary center in Turkey and literature review

Sibel Laçinel Gürlevik et al. Eur J Paediatr Neurol. 2022 Mar.

Abstract

Background: Since December 2019, coronavirus disease 2019 (COVID-19) has become a global pandemic caused by highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although respiratory disease and multisystem inflammatory syndrome in children (MIS-C) are main clinical presentations in children, numerous neurological manifestations are being described increasingly. We aimed to investigate new onset neurological symptoms associated with SARS-CoV-2 in pediatric patients in order to establish a possible relationship as well as to understand the underlying pathophysiological mechanisms between SARS-CoV-2 infection and neurological findings.

Methods: We analyzed retrospectively children who had neurologic manifestations temporally associated with SARS-CoV-2 infection at Hacettepe University İhsan Doğramaci Children's Hospital. We performed a literature search between March 20, 2020 and March 30, 2021. Articles that report children with COVID-19 related neurological manifestations were included.

Results: We have observed 15 consecutive cases with new onset neurological manifestations along with confirmed SARS-CoV-2 infection. Age at hospitalization ranged from three months to 17 years. Ten patients had central nervous system involvement, and most common manifestation was encephalopathy (5/10), which is also one of the most common manifestations of the patients mentioned in the relevant 39 articles we reviewed.

Conclusion: Children with COVID-19 can present with neurologic findings such as encephalopathy, seizures, cerebrovascular events as well as abnormal eye movements. Clinical suspicion and awareness are required to show the association between neurologic manifestations and COVID-19.

Keywords: COVID-19; Children; MIS-C; Neurology; SARS-CoV-2; Seizure.

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Conflict of interest statement

The authors have indicated they have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Literature review flow diagram.
Fig. 2
Fig. 2
(A–H). Neuroimaging Studies of Cases. A. Postcontrast coronal T1W MR image shows diffuse leptomeningeal contrast enhancement in Case 1. B. Axial diffusion-weighted imaging (DWI) demonstrates a punctate diffusion restriction (arrow) in Case 1. C. In another patient (Case 3), axial DWI showing dorsal medullar punctate diffusion restriction (arrow). D. Axial T2W MR image reveals distension of the peri-optic nerve subarachnoid space and tortuosity in Case 11 (arrows). Bottom line is MR images of Case 13 with ‘multisystem inflammatory syndrome in children’ (E–H). Postcontrast coronal T1W MR image shows ependymal contrast enhancement (E, arrow) and axial postcontrast image shows cortical contrast enhancement (F, arrows) in the bilateral occipital lobes. Susceptibility-weighted image revealing parenchymal microhemorrhages (G, arrows) and bilateral middle cerebral artery stenosis in time-of-flight MR angiography (H, arrows).
Fig. 3
Fig. 3
Most common presenting neurological features in children with COVID -19 based on the review of 39 case reports and series from around the World.
See this image and copyright information in PMC

Comment in

  • Neuro-COVID is not at variance between children and adults.
    Finsterer J, Matovu D. Finsterer J, et al. Eur J Paediatr Neurol. 2022 Jul;39:116-117. doi: 10.1016/j.ejpn.2022.06.005. Epub 2022 Jun 15. Eur J Paediatr Neurol. 2022. PMID: 35718700 Free PMC article. No abstract available.
  • Neurologic manifestations in children with COVID-19.
    Gürlevik SL, Günbey C, Ozsurekci Y, Kesici S, Gocmen R, Temucin Ç, Özen S, Cengiz AB, Yalnızoglu D. Gürlevik SL, et al. Eur J Paediatr Neurol. 2022 Jul;39:118-119. doi: 10.1016/j.ejpn.2022.06.004. Epub 2022 Jun 13. Eur J Paediatr Neurol. 2022. PMID: 35781422 Free PMC article. No abstract available.

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Supplementary concepts