Khair Abdulhafeez
Neurology, Nemours Children's Health, Thomas Jefferson University, Wilmington, USA.
Cureus. 2021 Oct 30;13(10):e19149. doi: 10.7759/cureus.19149. eCollection 2021 Oct.
Data on neurological sequelae of COVID-19 infection in children are sparse. Neurotropic and neuroinvasive potentials of the SARS-CoV-2 virus are a matter of ongoing scientific debate and not yet well understood. Most of the reported symptoms are nonspecific including headache, encephalopathy, weakness, and as a part of multisystem inflammatory response syndrome. Few observational studies have reported acute encephalopathy to be one of the neurological manifestations of COVID-19 infection, mostly in adults. A little is known about epileptogenesis or electroencephalogram (EEG) findings in this limited cohort of pediatric patients. We report a 17-year-old female with type 1 diabetes mellitus (DM), who presented with two weeks history of intermittent headaches, followed by a one-day history of acute change in behavior in the form of prolonged staring, decreased speech, confusion, and alternating periods of agitation and sleepiness. No fever or respiratory symptoms. Her blood glucose was normal. Brain MRI was unremarkable. Cerebrospinal fluid (CSF) studies showed 1000 RBCs, no WBCs, normal glucose/protein, negative culture, and negative infectious PCR, and autoimmune panels. She was found to be positive for SARS-CoV-2 PCR with negative IgG. Her EEG showed remarkable background slowing and frequent frontal intermittent rhythmic discharges. She was managed with high-dose steroids with the full clinical recovery of all symptoms at discharge, as well as normalization of subsequent EEG studies. We hypothesize there may be some specific seizure characteristics or EEG patterns in patients with pediatric COVID-19 infection and concomitant acute encephalopathy. It is perhaps reasonable to obtain EEG studies in children who test positive for SARS-CoV-2 and report central neurological symptoms. Long-term follow-up of this cohort of patients will be helpful to understand the clinical significance and implications of such neurophysiological studies.
关于儿童新冠病毒感染神经后遗症的数据稀少。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）病毒的嗜神经性和神经侵袭潜力仍是科学上持续争论的问题，尚未得到充分了解。报告的大多数症状是非特异性的，包括头痛、脑病、虚弱，以及作为多系统炎症反应综合征的一部分。很少有观察性研究报告急性脑病是新冠病毒感染的神经表现之一，主要见于成人。对于这一有限的儿科患者队列中的癫痫发生或脑电图（EEG）结果了解甚少。我们报告一名17岁1型糖尿病（DM）女性，她有两周间歇性头痛病史，随后出现一天行为急性改变，表现为长时间凝视、言语减少、意识模糊，以及交替出现的烦躁和嗜睡。无发热或呼吸道症状。她的血糖正常。脑部磁共振成像（MRI）无异常。脑脊液（CSF）检查显示有1000个红细胞，无白细胞，葡萄糖/蛋白质正常，培养阴性，感染性聚合酶链反应（PCR）阴性，自身免疫检查结果也为阴性。她的SARS-CoV-2 PCR检测呈阳性，免疫球蛋白G（IgG）阴性。她的脑电图显示背景明显减慢，频繁出现额叶间歇性节律性放电。她接受了大剂量类固醇治疗，出院时所有症状完全临床康复，随后的脑电图检查也恢复正常。我们推测，儿童新冠病毒感染并伴有急性脑病的患者可能存在一些特定的癫痫特征或脑电图模式。对于SARS-CoV-2检测呈阳性并报告有中枢神经系统症状的儿童，进行脑电图检查可能是合理的。对这一患者队列进行长期随访将有助于了解此类神经生理学研究的临床意义和影响。
