Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children
Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children
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DOI：
10.1001/jamaneurol.2020.2687
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发表时间：
2020-11-01
期刊：
影响因子：
29
通讯作者：
Hacohen, Yael
中科院分区：
文献类型：
--
作者：
Abdel-Mannan, Omar;Eyre, Michael;Hacohen, Yael
本病例系列介绍了4名出现2019冠状病毒病神经系统症状的儿童的临床表现。儿童冠状病毒病2019 （COVID-19）有哪些神经学表现？发现4例新冠肺炎患儿伴神经系统症状，4例患儿神经影像学均表现为胼胝体脾信号改变，需住院重症监护治疗新冠肺炎儿童多系统炎症综合征。这意味着，在没有呼吸道症状的情况下，COVID-19患儿可能出现新的神经系统症状，包括中枢和周围神经系统以及影像学上的脾脏改变；这一诊断应在脾病变的鉴别诊断中加以考虑。由高致病性病毒严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）成人出现神经系统症状。目的报道新冠肺炎患儿的神经学表现。在本病例系列研究中，纳入了2020年3月1日至2020年5月8日期间在大奥蒙德街儿童医院（英国伦敦）出现SARS-CoV-2感染和神经系统症状的年龄小于18岁的患者，这些患者通过鼻咽拭子定量逆转录聚合酶链反应试验确认感染，或血清中针对SARS-CoV-2的IgG抗体检测结果阳性。主要结果和测量从电子病历中检索临床和临床旁特征。结果27例小儿COVID-19多系统炎症综合征患儿中，既往健康的4例（14.8%）出现新发神经系统症状。症状包括脑病、头痛、脑干和小脑症状、肌肉无力和反射减弱。所有4例患者都需要进入重症监护病房治疗COVID-19儿童多系统炎症综合征。4例患者脑磁共振成像均可见脾信号改变。2例脑脊液检测患者标本为脱细胞性，聚合酶链反应或培养均无感染证据（包括SARS-CoV-2聚合酶链反应阴性），寡克隆带检测阴性。在所有3例接受脑电图检查的患者中，均发现轻度过度缓慢活动。所有患者的n-甲基-d-天冬氨酸受体、髓鞘少突胶质细胞糖蛋白和水通道蛋白-4自身抗体检测均为阴性。所有3例患者均行神经传导检查和肌电图检查，均可见轻度肌病和神经性改变。所有患者的神经系统均有改善，其中2名患者在研究结束时完全康复。在本病例系列研究中，在没有呼吸道症状的情况下，COVID-19患儿在影像学上表现为新的神经系统症状，包括中枢和周围神经系统以及脾脏改变。需要进一步的研究来评估COVID-19儿童中神经系统症状与免疫介导的变化之间的关系。
This case series presents the clinical findings of 4 children who experienced neurological manifestations of coronavirus disease 2019.Question What are the neurological manifestations of coronavirus disease 2019 (COVID-19) in children? Findings In a case series of 4 children with COVID-19 and neurological symptoms, all 4 patients had signal changes in the splenium of the corpus callosum on neuroimaging and required intensive care admission for the treatment of COVID-19 pediatric multisystem inflammatory syndrome. Meaning Children with COVID-19 may present with new neurological symptoms involving both the central and peripheral nervous system and splenial changes on imaging, in the absence of respiratory symptoms; this diagnosis should be considered within the differential diagnosis of splenial lesions.Importance Neurological manifestations have been reported in adults with coronavirus disease 2019 (COVID-19), which is caused by the highly pathogenic virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective To report the neurological manifestations of children with COVID-19. Design, Setting, and Participants In this case-series study, patients younger than 18 years who presented with SARS-CoV-2 infection and neurological symptoms to Great Ormond Street Hospital for Children (London, UK) between March 1, 2020, and May 8, 2020, were included after infection was confirmed by either a quantitative reverse transcription-polymerase chain reaction assay by nasopharyngeal swab or a positive test result for IgG antibodies against SARS-CoV-2 in serum. Main Outcomes and Measures Clinical and paraclinical features were retrieved from electronic patient records. Results Of the 27 children with COVID-19 pediatric multisystem inflammatory syndrome, 4 patients (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 4 patients required intensive care unit admission for the treatment of COVID-19 pediatric multisystem inflammatory syndrome. Splenium signal changes were seen in all 4 patients on magnetic resonance imaging of the brain. In the 2 patients whose cerebrospinal fluid was tested, samples were acellular, with no evidence of infection on polymerase chain reaction or culture (including negative SARS-CoV-2 polymerase chain reaction results) and negative oligoclonal band test results. In all 3 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 3 patients who underwent nerve conduction studies and electromyography, mild myopathic and neuropathic changes were seen. Neurological improvement was seen in all patients, with 2 making a complete recovery by the end of the study. Conclusions and Relevance In this case-series study, children with COVID-19 presented with new neurological symptoms involving both the central and peripheral nervous systems and splenial changes on imaging, in the absence of respiratory symptoms. Additional research is needed to assess the association of neurological symptoms with immune-mediated changes among children with COVID-19.