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Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study

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 neu...

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Autores principales: Lindan, Camilla E, Mankad, Kshitij, Ram, Dipak, Kociolek, Larry K, Silvera, V Michelle, Boddaert, Nathalie, Stivaros, Stavros Michael, Palasis, Susan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Ltd. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744016/
https://www.ncbi.nlm.nih.gov/pubmed/33338439
http://dx.doi.org/10.1016/S2352-4642(20)30362-X
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author Lindan, Camilla E
Mankad, Kshitij
Ram, Dipak
Kociolek, Larry K
Silvera, V Michelle
Boddaert, Nathalie
Stivaros, Stavros Michael
Palasis, Susan
author_facet Lindan, Camilla E
Mankad, Kshitij
Ram, Dipak
Kociolek, Larry K
Silvera, V Michelle
Boddaert, Nathalie
Stivaros, Stavros Michael
Palasis, Susan
author_sort Lindan, Camilla E
collection PubMed
description 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:
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spelling pubmed-77440162020-12-17 Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study Lindan, Camilla E Mankad, Kshitij Ram, Dipak Kociolek, Larry K Silvera, V Michelle Boddaert, Nathalie Stivaros, Stavros Michael Palasis, Susan Lancet Child Adolesc Health Articles 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: Elsevier Ltd. 2021-03 2020-12-16 /pmc/articles/PMC7744016/ /pubmed/33338439 http://dx.doi.org/10.1016/S2352-4642(20)30362-X Text en © 2020 Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Articles
Lindan, Camilla E
Mankad, Kshitij
Ram, Dipak
Kociolek, Larry K
Silvera, V Michelle
Boddaert, Nathalie
Stivaros, Stavros Michael
Palasis, Susan
Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study
title Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study
title_full Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study
title_fullStr Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study
title_full_unstemmed Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study
title_short Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study
title_sort neuroimaging manifestations in children with sars-cov-2 infection: a multinational, multicentre collaborative study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7744016/
https://www.ncbi.nlm.nih.gov/pubmed/33338439
http://dx.doi.org/10.1016/S2352-4642(20)30362-X
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