CLINICAL CASE OF COVID-19-ASSOCIATED MENINGOENCEPHALITIS
Keywords:
COVID-19, сoronavirus infection, meningoencephalitis, neurological symptoms, SARS-CoV-2, children.Abstract
Relevance. In 2019, the world faced a previously unexplored infection, one after another, the pandemic covered cities, countries and in a matter of months engulfed the whole world. Since the first reports of SARS-CoV-2 infection, many studies have been published on the epidemiological aspects of COVID-19, including clinical manifestations and outcomes. Most of these studies have focused on respiratory complications. However, recent results have revealed the systemic effects of the virus, including its potential effects on the nervous system.
The purpose of the study. To describe the clinical manifestation of neurological symptoms and COVID-19 infection in a child.
Material and methods. Clinical neurological examination, neuroimaging (MRI of the brain), virological examination by immuno-enzyme analysis.
Results. According to the results of a comprehensive study, the diagnosis was made: Organic brain damage, as a consequence of neuroinfection (combined with EBV+CVI), with multifocal foci of encephalitis, including multiple vascular thrombosis and thrombosis of the sagittal sinus in combination with PVL. Pseudobulbar syndrome. Gross dystonia syndrome. Localized symptomatic epilepsy. Partial atrophy of the optic nerve of both eyes.
Discussion. Not a little is said that COVID-19 causes severe complications not only from the nervous system, but also internal organs, blood vessels and other vital systems. In Kazakhstan, as well as in other countries, neurological complications of COVID-19 are at the stage of data collection and study. Doctors from different countries recognize that COVID-19 is not only a respiratory infection, but also a multisystem disease, which means that in practice you can face its various consequences. One of these cases is this child who has severe complications, up to the need to resolve the issue of palliative care.
Conclusion. Drawing conclusions, taking into account all the data, including anatomical and physiological features of the central nervous system of young children, the tendency to massive inflammatory reactions of brain tissues and rapid progression of the process is not excluded.
References
1. Lin JE, Asfour A, Sewell TB, Hooe B, Pryce P, Earley C, Shen MY, Kerner-Rossi M, Thakur KT, Vargas WS, Silver WG, Geneslaw AS. Neurological issues in children with COVID-19. Neurosci Lett. 2021 Jan 19;743:135567. doi: 10.1016/j.neulet.2020.135567. Epub 2020 Dec 19. PMID: 33352286; PMCID: PMC7831718
2. Toubiana J, Poirault C, Corsia A, Bajolle F, Fourgeaud J, Angoulvant F, Debray A, Basmaci R, Salvador E, Biscardi S, Frange P, Chalumeau M, Casanova JL, Cohen JF, Allali S. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ. 2020 Jun 3;369:m2094. doi: 10.1136/bmj.m2094. PMID: 32493739; PMCID: PMC7500538
3. Abdel-Mannan O, Eyre M, Löbel U, Bamford A, Eltze C, Hameed B, Hemingway C, Hacohen Y. Neurologic and radiographic findings associated with COVID-19 infection in children. JAMA Neurol. 2020;77(11):1–6. doi: 10.1001/jamaneurol.2020.2687. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
4. Abel D, Shen MY, Abid Z, Hennigan C, Boneparth A, Miller EH, Uhlemann AC, McBrian DK, Thakur K, Silver W, Bain JM. Encephalopathy and bilateral thalamic lesions in a child with MIS-C associated with COVID-19. Neurology. 2020;95(16):745–748. doi: 10.1212/WNL.0000000000010652. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
5. Asif R, O' Mahony, M. S. Rare complication of COVID-19 presenting as isolated headache. BMJ Case Rep. 2020;13(10):e239275. doi: 10.1136/bcr-2020-239275. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
6. Baccarella A, Linder A, Spencer R, Jonokuchi AJ, King PB, Maldonado-Soto A, Boneparth A, Hooe BS, Schweickert AJ, Carlin RF, Kingery F, Vargas WS, Sewell TB, Silver WG. Increased intracranial pressure in the setting of multisystem inflammatory syndrome in children, associated with COVID-19. Pediatr Neurol. 2021;115:48–49 doi: 10.1016/j.pediatrneurol.2020.11.008. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
7. Basirjafari S, Rafiee M, Shahhosseini B, Mohammadi M, Aghayari Sheikh Neshin S, Zarei M. Association of pediatric COVID-19 and subarachnoid hemorrhage. J Med Virol. 2021;93(2):658–660. doi: 10.1002/jmv.26434. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
8. Bektaş G, Akçay N, Boydağ K, Şevketoğlu E. Reversible splenial lesion syndrome associated with SARS-CoV-2 infection in two children. Brain Dev. 2021;43(2):230–233. doi: 10.1016/j.braindev.2020.10.002. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
9. Bhatta S, Sayed A, Ranabhat B, Bhatta RK, Acharya Y. New-onset seizure as the only presentation in a child with COVID-19. Cureus. 2020;12(6):e8820. doi: 10.7759/cureus.8820. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
10. Burr T, Barton C, Doll E, Lakhotia A, Sweeney M. N-methyl-d-aspartate receptor encephalitis associated with COVID-19 infection in a toddler. Pediatr Neurol. 2021;114:75–76. doi: 10.1016/j.pediatrneurol.2020.10.002. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
11. Chiotos K, Bassiri H, Behrens EM, Blatz AM, Chang J, Diorio C, Fitzgerald JC, Topjian A, John A. Multisystem inflammatory syndrome in children during the coronavirus 2019 pandemic: a case series. J Pediatric Infect Dis Soc. 2020;9(3):393–398. doi: 10.1093/jpids/piaa069. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
12. Curtis M, Bhumbra S, Felker MV, Jordan BL, Kim J, Weber M, et al. Guillain-Barré syndrome in a child with COVID-19 infection. Pediatrics. 2021;147(4):e2020015115. 10.1542/peds.2020-015115. [PubMed]
13. de Miranda Henriques-Souza AM, de Melo A, de Aguiar Coelho Silva Madeiro B, Freitas LF, Sampaio Rocha-Filho PA, Gonçalves FG. Acute disseminated encephalomyelitis in a COVID-19 pediatric patient. Neuroradiology. 2021;63(1):141–145. doi: 10.1007/s00234-020-02571-0. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
14. De Paulis M, Oliveira D, Vieira RP, Pinto IC, Machado R, Cavalcanti MP, Soares CP, de Araujo A, Araujo DB, Bachi A, Leal FB, Dorlass EG, Gilio AE, Durigon EL, Barreira ER. Multisystem inflammatory syndrome associated with COVID-19 with neurologic manifestations in a child: a brief report. Pediatr Infect Dis J. 2020;39(10):e321–e324. doi: 10.1097/INF.0000000000002834. [PubMed] [CrossRef] [Google Scholar]
15. Emami A, Fadakar N, Akbari A, Lotfi M, Farazdaghi M, Javanmardi F, Rezaei T, Asadi-Pooya AA. Seizure in patients with COVID-19. Neurol Sci. 2020;41(11):3057–3061. doi: 10.1007/s10072-020-04731-9. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
16. Enner S, Hormozdyaran S, Varughese R, Milillo J, Pavkovic I, Laureta E, Schneider J, Kothare S. Central apnea in an adolescent with COVID-19. Pediatr Neurol. 2020;110:87–88. doi: 10.1016/j.pediatrneurol.2020.05.012. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
17. Frank C, Almeida T, Marques EA, de Sousa Monteiro Q, Feitoza P, Borba M, et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection in a pediatric patient. J Trop Pediatr. 2020;0:1–6. 10.1093/tropej/fmaa044. [PMC free article] [PubMed]
18. Gaur P, Dixon L, Jones B, Lyall H, Jan W. COVID-19-associated cytotoxic lesions of the Corpus callosum. AJNR Am J Neuroradiol. 2020;41(10):1905–1907. doi: 10.3174/ajnr.A6713. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
19. Gulko E, Overby P, Ali S, Mehta H, Al-Mufti F, Gomes W. Vessel Wall enhancement and focal cerebral Arteriopathy in a pediatric patient with acute infarct and COVID-19 infection. AJNR Am J Neuroradiol. 2020;41(12):2348–2350. doi: 10.3174/ajnr.A6778. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
20. Kaur H, Mason JA, Bajracharya M, McGee J, Gunderson MD, Hart BL, Dehority W, Link N, Moore B, Phillips JP, Rogers D. Transverse myelitis in a child with COVID-19. Pediatr Neurol. 2020;112:5–6. doi: 10.1016/j.pediatrneurol.2020.07.017. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
21. Khalifa M, Zakaria F, Ragab Y, Saad A, Bamaga A, Emad Y, Rasker JJ. Guillain-Barré syndrome associated with severe acute respiratory syndrome coronavirus 2 detection and coronavirus disease 2019 in a child. J Pediatr Infect Dis Soc. 2020;9(4):510–513. doi: 10.1093/jpids/piaa086. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
22. Kim MG, Stein AA, Overby P, Kleinman G, Nuoman R, Gulko E, Al-Mufti F, Pisapia JM, Muh CR. Fatal cerebral edema in a child with COVID-19. Pediatr Neurol. 2021;114:77–78. doi: 10.1016/j.pediatrneurol.2020.10.005. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
23. Lin J, Lawson EC, Verma S, Peterson RB, Sidhu R. Cytotoxic lesion of the Corpus callosum in an adolescent with multisystem inflammatory syndrome and SARS-CoV-2 infection. AJNR Am J Neuroradiol. 2020;41(11):2017–2019. doi: 10.3174/ajnr.A6755. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
24. Lorenz N, Treptow A, Schmidt S, Hofmann R, Raumer-Engler M, Heubner G, Gröber K. Neonatal early-onset infection with SARS-CoV-2 in a newborn presenting with encephalitic symptoms. Pediatr Infect Dis J. 2020;39(8):e212. doi: 10.1097/INF.0000000000002735. [PubMed] [CrossRef] [Google Scholar]
25. Manji HK, George U, Mkopi NP, Manji KP. Guillain-Barré syndrome associated with COVID-19 infection. Pan Afr Med J. 2020;35(Suppl 2):118. doi: 10.11604/pamj.supp.2020.35.2.25003. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
26. McAbee GN, Brosgol Y, Pavlakis S, Agha R, Gaffoor M. Encephalitis associated with COVID-19 infection in an 11-year-old child. Pediatr Neurol. 2020;109:94. doi: 10.1016/j.pediatrneurol.2020.04.013. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
27. Mirzaee S, Gonçalves FG, Mohammadifard M, Tavakoli SM, Vossough A. Focal cerebral Arteriopathy in a pediatric patient with COVID-19. Radiology. 2020;297(2):E274–E275. doi: 10.1148/radiol.2020202197. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
28. Moreno-Galarraga L, Urretavizcaya-Martínez M, Alegría Echauri J, García Howard M, Ruperez García E, Aguilera-Albesa S, Alzina de Aguilar V, Herranz Aguirre M. SARS-CoV-2 infection in children requiring hospitalization: the experience of Navarra, Spain. World J Pediatr. 2020;16(6):614–622. doi: 10.1007/s12519-020-00393-x. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
29. Natarajan S, Ganesh R, Palaniappan N, Kannan L. SARS-CoV- 2 encephalitis in an adolescent girl. Indian Pediatr. 2020;57(12):1186–1187. doi: 10.1007/s13312-020-2080-7. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
30. Paybast S, Gorji R, Mavandadi S. Guillain-Barré syndrome as a neurological complication of novel COVID-19 infection: a case report and review of the literature. Neurologist. 2020;25(4):101–103. doi: 10.1097/NRL.0000000000000291. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
31. Raj SL, Vasanthi T, Baineni R, Sivabalan S. Neurological manifestations of COVID-19 in children. Indian Pediatr. 2020;57(12):1185–1186. doi: 10.1007/s13312-020-2079-0. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
32. Regev T, Antebi M, Eytan D, Shachor-Meyouhas Y, Ilivitzki A, Aviel YB, Ben-Ari J. Pediatric inflammatory multisystem syndrome with central nervous system involvement and Hypocomplementemia following SARS-COV-2 infection. Pediatr Infect Dis J. 2020;39(8):e206–e207. doi: 10.1097/INF.0000000000002804. [PubMed] [CrossRef] [Google Scholar]
33. Roussel A, Germanaud D, Bouchoucha Y, Ouldali N, Vedrenne-Cloquet M, Castelle M, Baruchel A. Cranial polyneuropathy as the first manifestation of a severe COVID-19 in a child. Pediatr Blood Cancer. 2021;68(3):e28707. doi: 10.1002/pbc.28707. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
34. Saeed A, Shorafa E. Status epilepticus as a first presentation of COVID-19 infection in a 3 years old boy; case report and review the literature. IDCases. 2020;22:e00942. doi: 10.1016/j.idcr.2020.e00942. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
35. Savić D, Alsheikh TM, Alhaj AK, Lazovic L, Alsarraf L, Bosnjakovic P, Yousef W. Ruptured cerebral pseudoaneurysm in an adolescent as an early onset of COVID-19 infection: case report. Acta Neurochir. 2020;162(11):2725–2729. doi: 10.1007/s00701-020-04510-7. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
36. Schupper AJ, Yaeger KA, Morgenstern PF. Neurological manifestations of pediatric multi-system inflammatory syndrome potentially associated with COVID-19. Child Nervous Syst. 2020;36(8):1579–1580. doi: 10.1007/s00381-020-04755-8. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
37. Seth V, Kushwaha S. Headache due to COVID-19: a disabling combination. Headache. 2020;60(10):2618–2621. doi: 10.1111/head.14006. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
38. Shenker J, Trogen B, Schroeder L, Ratner AJ, Kahn P. Multisystem inflammatory syndrome in children associated with status epilepticus. J Pediatr. 2020;227:300–301. doi: 10.1016/j.jpeds.2020.07.062. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
39. Swarz JA, Daily S, Niemi E, Hilbert SG, Ibrahim HA, Gaitanis JN. COVID-19 infection presenting as acute-onset focal status epilepticus. Pediatr Neurol. 2020;112:7. doi: 10.1016/j.pediatrneurol.2020.07.012. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
40. Theophanous C, Santoro JD, Itani R. Bell's palsy in a pediatric patient with hyper IgM syndrome and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Brain Dev. 2021;43(2):357–359. doi: 10.1016/j.braindev.2020.08.017. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
41. Tiwari L, Shekhar S, Bansal A, Kumar S. COVID-19 associated arterial ischaemic stroke and multisystem inflammatory syndrome in children: a case report. The Lancet Child Adolesc Health. 2021;5(1):88–90. doi: 10.1016/S2352-4642(20)30314-X. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
42. Verkuil LD, Liu GT, Brahma VL, Avery RA. Pseudotumor cerebri syndrome associated with MIS-C: a case report. Lancet (London, England). 2020;396(10250):532. doi: 10.1016/S0140-6736(20)31725-6. [PubMed] [CrossRef] [Google Scholar]
43. Vivanti AJ, Vauloup-Fellous C, Prevot S, Zupan V, Suffee C, Do Cao J, Benachi A, De Luca D. Transplacental transmission of SARS-CoV-2 infection. Nat Commun. 2020;11(1):3572. doi: 10.1038/s41467-020-17436-6. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
44. Yousefi K, Poorbarat S, Abasi Z, Rahimi S, Khakshour A. Viral meningitis associated with COVID-19 in a 9-year-old child: a case report. Pediatr Infect Dis J. 2021;40(2):e87–e98. doi: 10.1097/INF.0000000000002979. [PubMed] [CrossRef] [Google Scholar]
45. Zombori L, Bacon M, Wood H, Chatterjee F, Venkateswaran R, Lampariello S, Yoong M. Severe cortical damage associated with COVID-19 case report. Seizure. 2021;84:66–68. doi: 10.1016/j.seizure.2020.11.014. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
46. Siracusa L, Cascio A, Giordano S, Medaglia AA, Restivo GA, Pirrone I, Saia GF, Collura F, Colomba C. Neurological complications in pediatric patients with SARS-CoV-2 infection: a systematic review of the literature. Ital J Pediatr. 2021 Jun 2;47(1):123. doi: 10.1186/s13052-021-01066-9. PMID: 34078441; PMCID: PMC8170632.
47. Solomay TV, Semenenko TA, Filatov NN, Vedunova SL, Lavrov VF, Smirnova DI. Gracheva AV, Faizuloev EB. Reactivation of Epstein–Barr virus (Herpesviridae: Lymphocryptovirus, HHV-4) infection during COVID-19: epidemiological features. Problemy virusologii = Problems of Virology. 2021;66(2):152-161. (In Russ.) https://doi.org/10.36233/0507-4088-40
48. Siow I, Lee KS, Zhang JJY, Saffari SE, Ng A. Encephalitis as a neurological complication of COVID-19: A systematic review and meta-analysis of incidence, outcomes, and predictors. Eur J Neurol. 2021 Oct;28(10):3491-3502. doi: 10.1111/ene.14913. Epub 2021 Jun 2. PMID: 33982853; PMCID: PMC8239820
