Acute Ischemic Stroke in a Young Child and Its Association with SARS-CoV-2 Infection

Nivya Shree; Anitha Kommalur; Lakshmi M.; Mallesh Kariyappa; Sahana Devadas; Dhanalakshmi Kumble; Sushma Veeranna Sajjan; Ravichandra Kothur Rangegowda; Ashray Sudarshan Patel

doi:10.1055/s-0041-1736601

Journal of Pediatric Neurology, Table of Contents

Journal of Pediatric Neurology 2022; 20(05): 341-345
DOI: 10.1055/s-0041-1736601

Case Report

Acute Ischemic Stroke in a Young Child and Its Association with SARS-CoV-2 Infection

Nivya Shree

¹Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

,

Anitha Kommalur

¹Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

,

Lakshmi M.

¹Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

,

Mallesh Kariyappa

¹Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

,

Sahana Devadas

¹Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

,

Dhanalakshmi Kumble

¹Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

,

Sushma Veeranna Sajjan

¹Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

,

Ravichandra Kothur Rangegowda

¹Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

,

Ashray Sudarshan Patel

¹Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

› Author Affiliations

Abstract

The coronavirus disease 2019 (COVID-19) in children has been shown to have lower morbidity and mortality in children as compared with adults. The neurological complications related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly reported in children, yet the cerebrovascular complications are rare. We report a case of a toddler who presented with right-sided hemiparesis and motor aphasia, with an antecedent history suggestive of COVID-19 infection. The child tested negative on the nasopharyngeal swab for real-time reverse transcription-polymerase chain reaction (RT-PCR), but the serology for anti-SARS-CoV-2 IgG assay was positive. The neuroimaging showed an acute infarct in the left middle cerebral artery territory. A detailed evaluation for causes of childhood stroke was unrevealing, except for the presence of severe iron deficiency anemia (IDA). The child was diagnosed as acute ischemic stroke (AIS) most probably secondary to mild COVID-19 infection. The objective of this case report is to explain the possibility of AIS after a mild COVID-19 infection, complicated by the underlying severe IDA. Therefore, an association between COVID-19 and stroke in children needs to be emphasized and RT-PCR for SARS-CoV-2 as well as serological assay must be included in the workup of stroke in the young.

Keywords

SARS-CoV-2 - neurological manifestations - COVID-19 - acute ischemic stroke

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References

References
1 Sarangi B, Reddy VS, Oswal JS. et al. Epidemiological and clinical characteristics of COVID-19 in Indian children in the initial phase of the pandemic. Indian Pediatr 2020; 57 (10) 914-917
2 Alsohime F, Temsah MH, Al-Nemri AM, Somily AM, Al-Subaie S. COVID-19 infection prevalence in pediatric population: etiology, clinical presentation, and outcome. J Infect Public Health 2020; 13 (12) 1791-1796
3 Stafstrom CE, Jantzie LL. COVID-19: neurological considerations in neonates and children. Children (Basel) 2020; 7 (09) 133
4 Indian Council of Medical Research. List of Rapid Antigen Test Kits for COVID-19 (Oropharyngeal/Nasopharyngeal swabs). dated 19.05.2021. Accessed October 5, 2021 from https://www.icmr.gov.in/pdf/covid/kits/archive/List_of_rapid_antigen_kits_19052021.pdf
5 Huges KH, Kaul KL. The Harriet Lane Handbook: First South Asia Edition. Philadelphia: Elsevier; 2017
6 ICMR-National Institute of Virology. Standard Operating Procedure for Detection of 2019 novel coronavirus (2019- nCoV) in suspected human cases by rRT-PCR: First Line Screening assay. Pune: ICMR-National Institute of Virology; 2020. . pp. 1–7
7 Wu Y, Xu X, Chen Z. et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun 2020; 87: 18-22
8 Koralnik IJ, Tyler KL. COVID-19: a global threat to the nervous system. Ann Neurol 2020; 88 (01) 1-11
9 Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci 2020; 11 (07) 995-998
10 Kaushik P, Kaushik M, Parveen S, Tabassum H, Parvez S. Cross-talk between key players in patients with COVID-19 and ischemic stroke: a review on neurobiological insight of the pandemic. Mol Neurobiol 2020; 57 (12) 4921-4928
11 Lin JE, Asfour A, Sewell TB. et al. Neurological issues in children with COVID-19. Neurosci Lett 2021; 743: 135567
12 Lindan CE, Mankad K, Ram D. et al; ASPNR PECOBIG Collaborator Group. Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study. Lancet Child Adolesc Health 2021; 5 (03) 167-177
13 Ray STJ, Abdel-Mannan O, Sa M. et al; CoroNerve study group. Neurological manifestations of SARS-CoV-2 infection in hospitalised children and adolescents in the UK: a prospective national cohort study. Lancet Child Adolesc Health 2021; 5 (09) 631-641
14 Maury A, Lyoubi A, Peiffer-Smadja N, de Broucker T, Meppiel E. Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: a narrative review for clinicians. Rev Neurol (Paris) 2021; 177 (1-2): 51-64
15 Sharifian-Dorche M, Huot P, Osherov M. et al. Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic. J Neurol Sci 2020; 417: 117085
16 Beslow LA, Linds AB, Fox CK. et al; International Pediatric Stroke Study Group. Pediatric ischemic stroke: an infrequent complication of SARS-CoV-2. Ann Neurol 2021; 89 (04) 657-665
17 Appavu B, Deng D, Dowling MM. et al. Arteritis and large vessel occlusive strokes in children after COVID-19 infection. Pediatrics 2021; 147 (03) e2020023440
18 Kaiafa G, Savopoulos C, Kanellos I. et al. Anemia and stroke: where do we stand?. Acta Neurol Scand 2017; 135 (06) 596-602
19 Maguire JL, deVeber G, Parkin PC. Association between iron-deficiency anemia and stroke in young children. Pediatrics 2007; 120 (05) 1053-1057
20 Hartfield DS, Lowry NJ, Keene DL, Yager JY. Iron deficiency: a cause of stroke in infants and children. Pediatr Neurol 1997; 16 (01) 50-53
21 Azab SF, Abdelsalam SM, Saleh SH. et al. Iron deficiency anemia as a risk factor for cerebrovascular events in early childhood: a case-control study. Ann Hematol 2014; 93 (04) 571-576
22 Sarna A, Porwal A, Ramesh S. et al. Characterisation of the types of anaemia prevalent among children and adolescents aged 1-19 years in India: a population-based study. Lancet Child Adolesc Health 2020; 4 (07) 515-525
23 Fullerton HJ, Elkind MS, Barkovich AJ. et al. The vascular effects of infection in pediatric stroke (VIPS) study. J Child Neurol 2011; 26 (09) 1101-1110
24 Gupta ML, Gothwal S, Gupta RK. et al. Duration of viral clearance in children with SARS-CoV-2 infection in Rajasthan, India. Indian Pediatr 2021; 58 (02) 123-125