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Serious neurological complication associated with COVID 19 and MISC: Do we need to be more vigilant?

Background: Children with Coronavirus disease (COVID 19) and Multisystemic inflammatory disorder of childhood (MISC) are at risk for serious neurological complications. The spectrum of neurological manifestations associated with infection is expanding. Objective: To describe serious neurological complications associated with hospitalized children with COVID 19 or MISC. Methodology: Case series of patients <12 years of age admitted during the COVID 19 pandemic with serious neurological complications and SARS-CoV-2 RTPCR positive and/or fulfilling the criteria for MISC. Acute neurological signs and symptoms at presentation or developing during the hospitalization were considered. Children with preexisting neurological disorders admitted with COVID 19 or MISC were excluded. Results: A total of 14 hospitalized children with COVID19 or MISC developed serious neurological complications. The mean age was 7.1 years (range from day 20 of life to 12 years), and 7 were boys. Six children (46%) were diagnosed with Landry Guillain barre syndrome (Acute motor axonal polyneuropathy subtype). Seven children presented with acute febrile encephalopathy and seizures associated with MISC. These included acute hemorrhagic leukoencephalopathy, acute ischemic stroke with arteriopathy, acute cerebellitis, acute disseminated encephalomyelitis, acute necrotizing encephalopathy and febrile infection-related status epilepticus (FIRES). One neonate developed acute cortical laminar necrosis following antenatal maternal COVID 19. Treatment included symptomatic management, steroids, IVIG and aspirin. The outcome was favourable in 11 children; neurological disability was persistent among four survivors. Conclusion: A range of life-threatening neurological complications were associated with COVID-19 or MISC. Long term follow up is desirable in view of persistent neurological disability among survivors.
Keywords: COVID 19, MISC, Encephalopathy, Seizures, Children

Renu Suthar
Post Graduate Institute of Medical Education and Research
India

Chandana Bhagwat
Post Graduate Institute of Medical Education and Research
India

Suresh Kumar
Post Graduate Institute of Medical Education and Research
India

Arnab Ghosh
Post Graduate Institute of Medical Education and Research
India

Arun Bansal
Post Graduate Institute of Medical Education and Research
India

Mini Singh
Post Graduate Institute of Medical Education and Research
India

Naveen Sankhyan
Post Graduate Institute of Medical Education and Research
India

 

 


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