Brain Involvement Common But Often Transient In Kids Hospitalized With COVID-19

Neurologic involvement is common in children and adolescents hospitalized with COVID-19 infection, clinicians from Boston have found.

In their descriptive study of 1,695 patients (median age, 9 years) hospitalized for acute COVID-19 or multisystem inflammatory syndrome in children (MIS-C), 365 (22%) had neurologic involvement.

While most children had transient symptoms, 43 (12%) developed life-threatening neurologic disorders related to COVID-19, 11 (26%) died, and 17 (40%) survived with new neurologic sequelae, according to the JAMA Neurology report.

The life-threatening neurologic conditions included severe encephalopathy, stroke, central nervous system infection/demyelination, Guillain-Barré syndrome/variants and acute fulminant cerebral edema.

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Compared with those without life-threatening conditions, those with life-threatening neurologic conditions had higher neutrophil-to-lymphocyte ratios and higher reported frequency of D-dimer greater than 3 mcg/mL fibrinogen equivalent units.

"Hispanic or Latino and non-Hispanic Black children and adolescents represent a high proportion of the cases with severe neurologic involvement. Further studies are needed to understand whether these groups have a greater predilection for neurologic involvement or are disproportionately exposed," Dr. Tina Young Poussaint, neuroradiologist at Boston Children's Hospital and co-first author of the study, told Reuters Health by email.

"Children with underlying neurologic disorders may be at increased risk of neurologic complications, but we also found that many children were previously healthy and did not have prior neurologic conditions," added co-first author Dr. Kerri LaRovere, neurologist at Boston Children's Hospital.

Dr. Poussaint said, "There should be a high index of suspicion for COVID-19-related neurologic involvement for any young individual presenting with a broad range of neurologic symptoms or severe neurologic conditions following exposure to COVID-19 or a positive SARS-CoV-2 test."

"Minimizing exposure by following the CDC guidelines even for healthy children is important because the full extent of neurologic involvement and long-term effects on cognition and development are unknown," Dr. Poussaint added.

This study was funded by the U.S. Centers for Disease Control and Prevention under a contract to Boston Children's Hospital.

—Megan Brooks

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