Children with COVID-19 may present with new onset neurological symptoms involving both the central and peripheral nervous system, and splenial changes on imaging in the absence of respiratory symptoms, according to a case-series study of hospitalised paediatric COVID-19 patients.
Neurological manifestations have already been reported in adults with COVID-19. This study, published in JAMA Neurology, examined the neurological manifestations of children who presented with SARS-CoV-2 infection and neurological symptoms to Great Ormond Street Hospital for Children, London.
Patients younger than 18 years, between 1 March 2020 and 8 May 2020, were included after infection was confirmed by either a quantitative reverse transcription-polymerase chain reaction (PCR) assay by nasopharyngeal swab or a positive test result for immunoglobulin G antibodies against SARS-CoV-2 in serum.
Of the 27 children with COVID-19 paediatric multisystem inflammatory syndrome, four (14.8%) who were previously healthy had new-onset neurological symptoms. Symptoms included encephalopathy, headaches, brainstem and cerebellar signs, muscle weakness and reduced reflexes.
All four patients required intensive care unit admission for the treatment of COVID-19 paediatric multisystem inflammatory syndrome.
Splenium signal changes were seen in all four patients on magnetic resonance imaging of the brain. In the patients whose cerebrospinal fluid was tested, samples were acellular, with no evidence of infection on PCR or culture (including negative SARS-CoV-2 PCR results) and negative oligoclonal band test results.
In all three patients who underwent electroencephalography, a mild excess of slow activity was found. Tests for N-methyl-d-aspartate receptor, myelin oligodendrocyte glycoprotein and aquaporin-4 autoantibodies had negative results in all patients.
In all three patients who underwent nerve conduction studies and electromyography, mild myopathic and neuropathic changes were seen.
Neurological improvement was seen in all patients, with two making a complete recovery by the end of the study.
Additional research is needed to assess the association of neurological symptoms with immune-mediated changes among children with COVID-19, the study authors said.