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. 2025 Nov 14:43:e2024293.
doi: 10.1590/1984-0462/2025/43/2024293. eCollection 2025.

Neurological manifestations associated with SARS-CoV-2 infection in pediatric patients: a systematic review

Bruna de Jesus Santos  1 , Emerson André Negrão do Nascimento  1 , Ludmila Oliveira Dos Reis  1 , Júlia Belém Lima  1 , Beatriz Belém Lima  1 , Luciana Fernandes Pastana Ramos  1
Affiliations

Neurological manifestations associated with SARS-CoV-2 infection in pediatric patients: a systematic review

Bruna de Jesus Santos et al. Rev Paul Pediatr. .

Abstract
in English, Portuguese

Objective: To conduct a systematic review to identify neurological symptoms associated with SARS-CoV-2 in patients aged zero to 19 years, highlighting the main symptoms and addressing the existing gap in age range coverage in current studies.

Data source: This study was registered in the International Prospective Register of Systematic Reviews - PROSPERO (CRD42024520151) and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA (2020) guidelines. Observational and interventional studies, including randomized clinical trials, investigating neurological manifestations in children and adolescents with confirmed SARS-CoV-2 infection were included. Searches were conducted in the United States National Library of Medicine/Medical Literature Analysis and Retrieval System Online (PubMed/MEDLINE), Cochrane Library, and Virtual Health Library (VHL) using Health Science Descriptors/Medical Subject Headings (DeCS/MeSH) terms in English, Spanish, and Portuguese, covering January 2020 to January 2024.

Data synthesis: The search identified 1283 records, of which 302 were excluded (outside of scope), 688 were removed after title/abstract screening, and 95 duplicates were discarded. Fulltext analysis of 198 articles resulted in the selection of 25 eligible studies. The most frequently reported neurological manifestations included seizures, headache, altered levels of consciousness, olfactory and gustatory disturbances, encephalopathy, and acute cerebrovascular diseases.

Conclusions: Neurological manifestations of COVID-19 in children are relatively common, ranging from mild symptoms such as headache and taste/smell disturbances to severe complications like seizures, stroke, altered consciousness, and encephalopathy. Prevalence varies across studies, underscoring the need for further research to clarify underlying mechanisms.

Objetivo:: Analisar os sintomas neurológicos associados ao SARS-CoV-2 em pacientes de zero a 19 anos, identificando os principais sintomas e abordando a lacuna existente na abrangência etária dos estudos atuais.

Fontes de dados:: Estudo registrado no International Prospective Register of Systematic Reviews — PROSPERO (CRD42024520151), segundo as diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses — PRISMA (2020). Foram incluídos estudos observacionais e intervencionais, entre os quais ensaios clínicos randomizados, que investigaram manifestações neurológicas em crianças e adolescentes com infecção confirmada por SARS-CoV-2. Descritores em Ciências da Saúde (DeCS) e Medical Subject Headings (MeSH) foram utilizados nas buscas realizadas nas bases de dados Biblioteca Nacional de Medicina dos Estados Unidos/ Sistema Online de Busca e Análise de Literatura Médica (PubMed/MEDLINE), Cochrane Library e Biblioteca Virtual em Saúde (BVS), nos idiomas inglês, espanhol e português, entre janeiro/2020 e janeiro/2024.

Síntese dos dados:: A busca resultou em 1.283 registros, sendo 302 excluídos (fora do escopo), 688 desconsiderados após a triagem de título e resumo e 95 duplicatas removidas. A análise de texto completo de 198 artigos levou à seleção de 25 estudos. As manifestações neurológicas mais frequentemente relatadas nos estudos incluídos foram convulsões, dor de cabeça, alterações no nível de consciência, distúrbios olfatórios e gustativos, encefalopatia e doenças cerebrovasculares agudas.

Conclusões:: As manifestações neurológicas da COVID-19 em crianças são relativamente comuns, variando de sintomas leves, como cefaleia e distúrbios no paladar e olfato, até complicações graves, incluindo convulsões, acidente vascular cerebral, alteração da consciência e encefalopatia. A prevalência dessas manifestações varia entre os estudos, destacando a necessidade de mais pesquisas para entender melhor os mecanismos subjacentes.

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Conflict of interest statement

Conflict of interests: The authors declare there is no conflict of interests.

Figures

Figure 1
Figure 1. Flow diagram of the study selection process.
See this image and copyright information in PMC

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