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Neurological Manifestations of Covid-19 In Children- An Indian Perspective

Objectives- COVID-19 infection is associated with varied neurological presentations. We present data of acute COVID-19-associated neurological illness(PCR/antibody-positive) from 2 tertiary-care centres across Mumbai. Methods- Retrospective observational study to analyse records of 88admitted patients with neurological symptoms over the three waves. Results- Acute neurological presentation in 88-patients admitted with COVID-19 related illness aged 1month-15years. Male:female was 1.6:1. Fifty-one were PCR-positive, 37antibody-reactive. Systemic features present in 70/88patients. Data classified as acute-encephalopathy(34), isolated seizures(23), neuropathy(12), stroke(11), movement-disorder(8). Acute-encephalopathy presented as demyelination(6), ANEC(5), leukoencephalopathy(4), virus-associated encephalopathy(19). One patient was MOG-positive, 1 NMDAR-positive. Stroke subgroup presented as 8 arterial strokes(3- posterior circulation, 2- MCA territory, 2- basal ganglia, 1-MCA+PCA territory) and 3cortical venous infarcts. Cranial-nerve neuropathies(3) were unilateral-palatal palsy(1) and isolated-facial palsy(2). GBS(9) was distributed as-AIDP(6), AMAN(2), AMSAN(1). Isolated seizures had status in2/21 cases. Movement disorders were dystonia(5), tremors and ataxia(3). EEG done in 35/88patients showed only background-slowing(14), interictal discharges(8), status(2), normal(11). Nine had co-existent TBM; 7antibody-positive, 2PCR-positive. One prior, 8-newly presented. Six patients had neurological predispositions (genetic epilepsy, tuberous sclerosis, craniopharyngioma, operated retinoblastoma, renal transplant). Intensive care was needed in 41/88 with 28requiring mechanical-ventilation, 30-immunomodulation (steroids, rituximab, tocilizumab, IVIG, plasmapheresis), 20-antithrombotic-treatment. Wave-1 had 27patients (11%incidence), wave-2 had 34(17%), wave-3 had 27(15%). Outcomes included no neurodeficit(43/88), discharge with neurodeficit(29/88) (hemiparesis, movement disorder, increased seizure frequency, aphasia, regression of milestones). Mortality in 4patients(2-TBM,1-basilar stroke,1-status epilepticus). Conclusion- SARS- CoV-2; respiratory pathogen, causes significant nervous system damage. All waves had similar incidence. Neuro-morbidity was significant with encephalopathy, movement disorders and GBS; isolated seizure patients recovered well.

Ruta Deo
NH SRCC Children's Hospital, Mumbai
India

Anish Ainapure
Bai Jerbai Wadia Hospital for Children
India

Shilpa Kulkarni
Bai Jerbai Wadia Hospital for Children
India

Anaita Udwadia
NH SRCC Children's Hospital, Mumbai
India

 


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