Neurologic involvement in children and adolescents with COVID-19 or multisystem inflammatory syndrome

1. 22% of children and adolescents hospitalized for COVID-19 related reasons developed neurologic symptoms, with 10% of these cases being life-threatening, with conditions such as encephalopathy, stroke, and CNS infection.

Evidence Rating Level: 4 (Below Average)

Although COVID-19 affects the respiratory system primarily, there have also been neurological disorders associated with the disease. In one early report from Wuhan, 36% of adults hospitalized with COVID-19 had neurologic symptoms. In children and adolescents with COVID-19, a rare illness known as multisystem inflammatory syndrome in children (MIS-C) has been identified, with case series studies n 2020 reporting 6-58% of MIS-C patients having central or peripheral nervous system issues. The aim of the current case series study was to characterize the type and severity of neurologic conditions for patients under 21 years of age, who were hospitalized for COVID-19 related reasons. Data was collected from 61 hospitals in 31 states across the United States, between March and December 2020. In total, 1695 patients (54% male) were included in the study, with a median age of 9.1 (interquartile range 2.4-15.3 years). Out of these, 365 patients (22%) had some form of neurologic involvement, which was more likely in patients with underlying neurologic disorders (22% versus 8%). The most common neurologic signs were seizures in children younger than 5, and anosmia/ageusia in patients between 13 and 20. In terms of survival, 96% and 99% of patients with and without neurologic involvement respectively were discharged alive. 43 of the 365 patients (12%) had life-threatening neurological involvement, with 79% not having had major underlying conditions, and 47% meeting the MIS-C criteria. The life-threatening conditions included severe encephalopathy (n=15), ischemic or hemorrhagic stroke (n=12), CNS infection (n=8), and cerebral edema (n=4). Out of these 43 patients, 11 passed away and 17 were discharged with neurologic deficits. Overall, the study found neurologic symptoms in about 1/5 of children and adolescents hospitalized for COVID-19 related reasons, which included some life-threatening and fatal cases.

Click to read the study in JAMA Neurology

Image: PD

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