Carotid Artery Dissection and Hemorrhagic Stroke in the Setting of Multisystem Inflammatory Syndrome in Children

An alarming and distressing delayed inflammatory response to Coronavirus Disease 2019 (COVID-19) has emerged in children and adolescents, a population previously thought to have been largely spared by this global pandemic. In April 2020, clinicians in the United Kingdom identified eight cases of previously healthy children testing positive for current or recent infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) presenting with Kawasaki disease-like features. From April 16 to May 4, 2020, New York City reported that 15 patients aged 2-15 years were hospitalized with a similar multisystem inflammatory syndrome, many requiring intensive care unit (ICU) admission. This syndrome is referred to either as pediatric inflammatory multisystem syndrome, or multisystem inflammatory syndrome in children (MIS-C). We present the case of an eight-year-old with MIS-C who developed carotid artery dissection following venoarterial extracorporeal membrane oxygenation (VA-ECMO) cannulation, followed by a subsequent hemorrhagic stroke in the basal ganglia.