Imaging of Pediatric Neuro-COVID: What We Learned

Although the overwhelming majority of the coronavirus disease 2019 (COVID-19) cases are encountered in adults, less commonly children succumb to the disease. As of January 2022, among the 3.5 million deaths reported, 0.4% (over 12,300) occurred in children and adolescents under 20 years of age. Out of over 12,300 deaths, 42% was encountered in children aged 0 to 9.[1]

Involvement of the neurological systems was recognized very early in the pandemic and The Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) was initiated as a multinational research collaborative in April 2020 to describe the prevalence and outcomes of neurological manifestations of the severe acute respiratory coronavirus 2 or multisystem inflammatory syndrome in children (MIS-C) in adults and children.[2] In an interim analysis of the GCS-NeuroCOVID data, information on 1,493 children was made available, of which 14% were diagnosed with MIS-C. Non-neurological symptoms were generally more common than neurological symptoms in children. In the GCS-NeuroCOVID group, 44% of the children presented with at least one neurological sign or symptom while 12% had two or more.[3] In decreasing frequency, headache (20%), encephalopathy (16%), and seizures (8%) were the most common presentations.[3] Anosmia, ageusia (lack of taste sensation), meningitis/encephalitis, and stroke were less common.

A myriad of neuroimaging manifestations can be encountered in pediatric COVID-19[4] including but not limited to acute demyelinating encephalomyelitis,[5] cerebellitis,[6] stroke,[7] focal cerebral arteriopathy,[8] posterior reversible encephalopathy syndrome,[9] [10] and eversible cerebral vasoconstriction syndrome.[11]

It is important that the imaging specialists and clinicians appraise the diverse imaging manifestations of pediatric neuro-COVID involvement. In this issue of Pediatric Neuroradiology, my esteemed colleagues prepared two articles focusing on the nonvascular and vascular manifestations of pediatric neuro-COVID. Our goal is to share our experience in the imaging of pediatric neuro-COVID with the medical community via image-rich manuscripts. We thank the editorial board of Pediatric Neuroradiology for this opportunity and hope the manuscripts will fulfill our stated goal.

Publication History

Received: 15 February 2022

Accepted: 15 February 2022

Article published online:
20 June 2022

• References

• 1 UNICEF COVID Data. Available at: https://data.unicef.org/topic/child-survival/covid-19/
• 2 Helbok R, Chou SH, Beghi E. et al; GCS-NeuroCOVID consortium, EAN COVID task force. NeuroCOVID: it's time to join forces globally. Lancet Neurol 2020; 19 (10) 805-806
• 3 Fink EL, Robertson CL, Wainwright MS. et al; Global Consortium Study of Neurologic Dysfunction in COVID-19 (GCS-NeuroCOVID) Investigators. Prevalence and risk factors of neurologic manifestations in hospitalized children diagnosed with acute SARS-CoV-2 or MIS-C. Pediatr Neurol 2022; 128: 33-44
• 4 Finsterer J. Imaging abnormalities in pediatric neuro-COVID are more diverse than specified. Biomed J 2021; (e-pub ahead of print) PMID: 34906744. DOI: 10.1016/j.bj.2021.12.001.
• 5 Maghrabi Y, Baeesa SS. Acute hemorrhagic myelitis in an adolescent with COVID-19: a case report and review of literature. Cureus 2021; 13 (12) e20553
• 6 Sotgiu S, Uzzau S, Pippia A, Carta A, Antonucci R. Expanding the spectrum of acute cerebellitis due to SARS-Cov-2. Pediatr Neurol 2021; 121: 1-2
• 7 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
• 8 Mirzaee SMM, Gonçalves FG, Mohammadifard M, Tavakoli SM, Vossough A. Focal cerebral arteriopathy in a pediatric patient with COVID-19. Radiology 2020; 297 (02) E274-E275
• 9 Arslan G, Besci T, Karaca Ö, Aylan Gelen S. Posterior reversible encephalopathy syndrome related to COVID-19 in a child. Pediatr Int (Roma) 2022; 64 (01) e14908
• 10 Korkmazer B, Ozogul M, Hikmat E. et al. Posterior reversible encephalopathy syndrome in a pediatric COVID-19 patient. Pediatr Infect Dis J 2021; 40 (06) e240-e242
• 11 Sadeghizadeh A, Pourmoghaddas Z, Zandifar A. et al. Reversible cerebral vasoconstriction syndrome and multisystem inflammatory syndrome in children with COVID-19. Pediatr Neurol 2022; 129: 1-6