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

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

Publikationsverlauf

Eingereicht: 11. Juni 2021

Angenommen: 18. September 2021

Artikel online veröffentlicht:
25. Oktober 2021

• 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 DOI: 10.3390/children7090133.
• 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 DOI: 10.1016/j.jns.2020.117085.
• 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 DOI: 10.1542/peds.2020-023440.
• 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