Pediatric Autoimmune Encephalitis Following COVID-19 Infection

Similar to the pathogenesis of autoimmune disease, SARS-CoV-2 (COVID-19) infection has been shown to be associated with dysregulated and persistent inflammatory reactions and production of some antibodies. We report 3 pediatric patients found to have serum SARS-CoV-2 antibodies who presented with neurologic findings suggestive of postinfectious autoimmune-mediated encephalitis. All 3 cases showed lymphocytic pleocytosis on cerebrospinal fluid studies and marked improvement in neurologic symptoms after high-dose intravenous corticosteroids. The manifestations of SARS-CoV-2 infection in the pediatric population are still an evolving area of study, and these cases suggest autoimmune-mediated encephalitis as yet another SARS-CoV-2 related complication.

The clinical, laboratory and prognostic characteristics of haemorrhagic stroke cases related to COVID-19 infection

Objective: Although ischemic and thrombotic vascular processes are more widely reported in COVID-19, the ratio of haemorrhagic cerebrovascular disease is lower. However, it needs to be evaluated because the mortality rate is higher in haemorrhages, and they may appear iatrogenically. Material and Methods: Patients observed at the Prof. Dr. Cemil Taşçıoğlu City Hospital between March 11th, 2020, and March 11th, 2021, were included in the study. Cases diagnosed as consecutive full intracerebral haemorrhage and concomitant with COVID-19 were observed during the study period. This study is a cross-sectional, retrospective, and observational study. Results: Within the 1-year period, 11 patients (7 men and 4 women) with a mean age of 64.45±18.68 years related to COVID-19 were recorded. Risk factors were high blood pressure at a frequency of 64%, diabetes mellitus at 45%, and the use of antiaggregants/anticoagulants at 36%. The ratio of male patients was 64% (n=7). The location of haemorrhage was intraparenchymal in 91% (n=10), and subdural in 9% (n=1). The mortality rate was 64%. Conclusion: Neurologic findings that develop, especially in noncooperating and prone patients in wards and intensive care units, must be observed carefully. Caution must be exercised in prophylactic antiaggregant and anticoagulant treatment, especially in high-risk patients. Intracranial haemorrhages are important due to high mortality.

Neurocutaneous Disorders

Neurocutaneous disorders, formerly called phakomatoses, are characterized by cutaneous and neurologic findings. Many are genetic, but some are sporadic. Often these disorders affect other organ systems as well and require lifetime surveillance for complications. Neurofibromatosis type 1 is the most common neurocutaneous disorder. With a prevalence of approximately 1 in 3,000 persons, it is more than 10 times more common than neurofibromatosis type 2.

Fatal tuberculous meningitis in an infant presenting with seizures in the UK

A 5-month-old male child of European background presented with sudden onset of prolonged afebrile seizures. He was intubated and transferred to the paediatric intensive care unit where he displayed abnormal neurology and remained ventilated. Brain MRI showed basal leptomeningeal enhancement suggesting malignancy or infection. Subsequent cerebrospinal fluid results of lymphocytic pleocytosis and raised protein were suggestive of tuberculous (TB) meningitis and anti-TB treatment was commenced empirically. Positive TB microbiology was eventually confirmed on respiratory secretions. The infant continued to show abnormal neurologic findings and repeated neuroimaging showed a new extensive cerebral infarct. The infant was compassionately extubated and passed away. The father was later found to have pulmonary TB. This case is an important reminder of TB meningitis for countries where TB is uncommon. The importance of considering TB in any child with abnormal neurology and of taking prompt family histories to identify children at risk is highlighted.

Epidural Hematoma in a Patient with Undiagnosed Vitamin K Deficiency: A Case Report

A 72 year old man presented for colostomy repair prompting epidural catheter placement for pain management. A prolonged activated partial thromboplastin time (aPTT) coupled with degenerative spine disease were noted prior to placement. Postoperatively, he developed shortness of breath and leg weakness. This impelled a computed tomography (CT) scan for pulmonary embolism (PE) evaluation, which revealed an epidural hematoma. Stable neurologic findings prompted conservative management. In conclusion, 1) prolongation in aPTT should prompt consideration before neuraxial procedures, 2) vitamin K deficiency is a risk factor for epidural hematoma, and 3) hematoma management should be dictated by progression of neurologic findings.

Neurologic findings among inpatients with COVID-19 at a safety-net US hospital

ObjectiveTo characterize the breadth of neurologic findings associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a diverse group of inpatients at an urban, safety-net US medical center.MethodsPatients were identified through an electronic medical record review from April 15, 2020, until July 1, 2020, at a large safety-net hospital in Boston, MA, caring primarily for underserved, low-income, and elderly patients. All hospitalized adult patients with positive nasopharyngeal swab or respiratory PCR testing for SARS-CoV-2 during their hospitalization or in the 30 days prior to admission who received an inpatient neurologic or neurocritical care consultation or admission during the study period were enrolled.ResultsSeventy-four patients were identified (42/57% male, median age 64 years). The majority of patients self-identified as Black or African-American (38, 51%). The most common neurologic symptoms at presentation to the hospital included altered mental status (39, 53%), fatigue (18, 24%), and headache (18, 18%). Fifteen patients had ischemic strokes (20%). There were 10 in-hospital mortalities, with moderately severe disability among survivors at discharge (14%, median modified Rankin Scale score of 4).ConclusionsNeurologic findings spanned inflammatory, vascular pathologies, sequelae of critical illness and metabolic derangements, possible direct involvement of the nervous system by SARS-CoV-2, and exacerbation of underlying neurologic conditions, highlighting a broad range of possible etiologies of neurologic complications in patients with coronavirus disease 2019 (COVID-19). Further studies are needed to characterize the infectious and post-infectious neurologic complications of COVID-19 in diverse patient populations.

A Comprehensive Review of Neurologic Manifestations of COVID-19 and Management of Pre-existing Neurologic Disorders in Children

Since the first reports of SARS-CoV-2 infection from China, multiple studies have been published regarding the epidemiologic aspects of COVID-19 including clinical manifestations and outcomes. The majority of these studies have focused on respiratory complications. However, recent findings have highlighted the systemic effects of the virus, including its potential impact on the nervous system. Similar to SARS-CoV-1, cellular entry of SARS-CoV-2 depends on the expression of ACE2, a receptor that is abundantly expressed in the nervous system. Neurologic manifestations in adults include cerebrovascular insults, encephalitis or encephalopathy, and neuromuscular disorders. However, the presence of these neurologic findings in the pediatric population is unclear. In this review, the potential neurotropism of SARS-CoV-2, known neurologic manifestations of COVID-19 in children, and management of preexisting pediatric neurologic conditions during the COVID-19 pandemic are discussed.