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Case Reports
. 2022 Mar 22;14(3):e23405.
doi: 10.7759/cureus.23405. eCollection 2022 Mar.

Para and Post-COVID-19 CNS Acute Demyelinating Disorders in Children: A Case Series on Expanding the Spectrum of Clinical and Radiological Characteristics

Abdulhafeez M Khair  1 , Rahul Nikam  2 , Sumair Husain  1 , Melanie Ortiz  1 , Gurcharanjeet Kaur  1
Affiliations
Case Reports

Para and Post-COVID-19 CNS Acute Demyelinating Disorders in Children: A Case Series on Expanding the Spectrum of Clinical and Radiological Characteristics

Abdulhafeez M Khair et al. Cureus. .

Abstract

Viral infections can serve as a trigger for variable autoimmune, antibody-mediated demyelinating disorders. There is accumulating evidence that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, causing coronavirus disease 2019 (COVID-19) infection and responsible for the current worldwide pandemic, can lead to a cascade of immune-mediated brain and spinal cord demyelinating injuries. However, such observation in the pediatric age group was only reported in very few patients. Thus, the heterogeneous spectrum of this phenomenon in children is still unfolding. We are reporting a case series of five pediatric patients with a variety of acute central nervous system (CNS) demyelinating disorders in the context of acute or recent COVID-19 infection. A 16-year-old female with anti-myelin oligodendrocyte glycoprotein (MOG) disorder, an eight-year-old male with acute disseminated encephalomyelitis (ADEM), a 13-year-old female with neuromyelitis optica spectrum disorder (NMOSD), and two 14 and 13-year-old females with new-onset multiple sclerosis (MS) are reported, all of whom presented acutely following COVID-19 infection. We propose that para and post-infectious CNS demyelinating disorders can potentially follow acute COVID-19 infection in children. Considering SARS-CoV-2 testing as a part of diagnostic workup is possibly useful. Awareness of the presence of this phenomenon can help in the recognition and management of those patients.

Keywords: a review; case report series; covid-19 in children; demyelinating neurological disorder; immune mediated phenomenon; post covid-19 manifestations.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Case 1: axial T2/FLAIR sequence with foci of white matter hyperintensity suggestive of demyelination
FLAIR: fluid-attenuated inversion recovery
Figure 2
Figure 2. Case 2: T2/FLAIR hyperintense lesions in the middle cerebellar peduncles with extension to the cerebellar white matter
FLAIR: fluid-attenuated inversion recovery
Figure 3
Figure 3. Case 3: Axial T2/FLAIR sequence showing asymmetric, non-enhancing, periventricular white matter hyperintensities
FLAIR: fluid-attenuated inversion recovery
Figure 4
Figure 4. Case 3: Sagittal T2 sequence of the cervical and upper thoracic spine, showing abnormal hyperintense signals in the medulla and cervical spinal cord
Figure 5
Figure 5. Case 4: Axial T2 MRI showing multiple, T2/FLAIR hyperintense, enhancing and non-enhancing focal lesions in the subcortical, periventricular, and deep white matter
FLAIR: fluid-attenuated inversion recovery
Figure 6
Figure 6. CNS neurological manifestations of COVID-19
ADEM: acute disseminated encephalomyelitis; PTSD: post-traumatic stress disorder; SV: superficial venous
See this image and copyright information in PMC

References

    1. Central nervous system manifestations of COVID-19: a systematic review. Asadi-Pooya AA, Simani L. J Neurol Sci. 2020;413:116832. - PMC - PubMed
    1. Nervous system involvement after infection with COVID-19 and other coronaviruses. Wu Y, Xu X, Chen Z, et al. Brain Behav Immun. 2020;87:18–22. - PMC - PubMed
    1. Vaccination-associated acute disseminated encephalomyelitis. Torisu H, Okada K. Vaccine. 2019;37:1126–1129. - PubMed
    1. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system? Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M, Talbot PJ. Viruses. 2019;12:14. - PMC - PubMed
    1. Filippi M, Rocca MA. White Matter Diseases. An Update for Neurologists. Switzerland: Springer Nature; 2020. Acute disseminated encephalomyelitis; pp. 109–125.

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