1. Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study
- Author
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Phil Riley, Gérard Chéron, Laureline Berteloot, Gilbert Vézina, Bryan Philbrook, Camilla Lindan, Kelsey E. Poisson, Yi Li, Shubra Pagariya, Fabiana C.C. Hirata, David Grevent, Judith Chareyre, Amna Kashgari, D. Gareth Evans, A Romsauerova, Marianne Leruez-Vill, Sniya Valsa Sudhakar, Thomas Blauwblomme, Loic De-Pontual, Larry K. Kociolek, Lokesh Lingappa, Charlies-Joris Roux, Ah Young Jung, Shilpa Kulkarni, Olivia Carney, Suely Fazio Ferraciolli, Ian Kamaly-Asl, Fabrício Guimarães Gonçalves, Fabrice Lesage, Suraj Amonkar, Jeffrey Jacob, Nadine Girard, Pascale Aouad, Robin Joseph, John-Paul Kilday, Alyssa Kirsch, Jose Alejandro Bacalla, Mélodie Aubart, Gilles Brun, Kshitij Mankad, Ulrike Löbel, Gaurav Saigal, Isabelle Sermet-Gaudelus, Wissam Elfallal, Pablo Picasso De Araujo Coimbra, Volodia Dangouloff-Ros, Jane Hassell, Robert A. Dineen, Roberto Lopez-Alberola, D. Ram, Jonathan G. Murnick, David Seidenwurm, Felice D'Arco, Jai Sidpra, Romain Basmaci, María Sol Toronchik, Nihaal Reddy, Manoelle Kossorotoff, Carlos Rugilo, Gabriel Lucca de Oliveira Salvador, Daniela Duarte Moreira, Sameen Akhtar, Sarah Nahmani, Raphaël Levy, Isabelle Desguerre, Julija Pavaine, Leandro Tavares Lucato, Kandise Jackson, Douglas Alden, Susan Palasis, Blaise V. Jones, Ana Cláudia Piovesan, P. Ellen Grant, Carolina Valduga de Alencastro Guimaraes, Stavros Stivaros, Ivan A. Gonzalez, V. Michelle Silvera, Anant Krishnan, Carol Cavalcante de Vasconcelos Lima, Nathalie Boddaert, Alcino A Barbosa, Radiologie pédiatrique et prénatale [Hôpital de la Timone - APHM], Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Centre de résonance magnétique biologique et médicale (CRMBM), and Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS)
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Encephalopathy ,Argentina ,Saudi Arabia ,India ,Myelitis ,Neuroimaging ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Central Nervous System Diseases ,[SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases ,030225 pediatrics ,Peru ,Developmental and Educational Psychology ,Humans ,Medicine ,Pediatrics, Perinatology, and Child Health ,030212 general & internal medicine ,Child ,Myositis ,ComputingMilieux_MISCELLANEOUS ,Neuroradiology ,Brain Diseases ,Coinfection ,SARS-CoV-2 ,business.industry ,Encephalomyelitis, Acute Disseminated ,COVID-19 ,Infant ,Articles ,medicine.disease ,Systemic Inflammatory Response Syndrome ,United Kingdom ,United States ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,France ,business ,Splenial ,Brazil - Abstract
Summary Background The CNS manifestations of COVID-19 in children have primarily been described in case reports, which limit the ability to appreciate the full spectrum of the disease in paediatric patients. We aimed to identify enough cases that could be evaluated in aggregate to better understand the neuroimaging manifestations of COVID-19 in the paediatric population. Methods An international call for cases of children with encephalopathy related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and abnormal neuroimaging findings was made. Clinical history and associated plasma and cerebrospinal fluid data were requested. These data were reviewed by a central neuroradiology panel, a child neurologist, and a paediatric infectious diseases expert. The children were categorised on the basis of their time of probable exposure to SARS-CoV-2. In addition, cases were excluded when a direct link to SARS-CoV-2 infection could not be established or an established alternate diagnostic cause could be hypothesised. The accepted referral centre imaging data, from ten countries, were remotely reviewed by a central panel of five paediatric neuroradiologists and a consensus opinion obtained on the imaging findings. Findings 38 children with neurological disease related to SARS-CoV-2 infection were identified from France (n=13), the UK (n=8), the USA (n=5), Brazil (n=4), Argentina (n=4), India (n=2), Peru (n=1), and Saudi Arabia (n=1). Recurring patterns of disease were identified, with neuroimaging abnormalities ranging from mild to severe. The most common imaging patterns were postinfectious immune-mediated acute disseminated encephalomyelitis-like changes of the brain (16 patients), myelitis (eight patients), and neural enhancement (13 patients). Cranial nerve enhancement could occur in the absence of corresponding neurological symptoms. Splenial lesions (seven patients) and myositis (four patients) were predominantly observed in children with multisystem inflammatory syndrome. Cerebrovascular complications in children were less common than in adults. Significant pre-existing conditions were absent and most children had favourable outcomes. However, fatal atypical CNS co-infections developed in four previously healthy children infected with SARS-CoV-2. Interpretation Acute-phase and delayed-phase SARS-CoV-2-related CNS abnormalities are seen in children. Recurring patterns of disease and atypical neuroimaging manifestations can be found and should be recognised being as potentially due to SARS-CoV-2 infection as an underlying aetiological factor. Studies of paediatric specific cohorts are needed to better understand the effects of SARS-CoV-2 infection on the CNS at presentation and on long-term follow-up in children. Funding American Society of Pediatric Neuroradiology, University of Manchester (Manchester, UK). Video Abstract Neuroimaging manifestations in children with SARS-CoV-2 infection
- Published
- 2021
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