Clinical Neurophysiology Department, Lille University Hospital, Lille, France.
Department of Pediatric Neurology, Lille University Hospital, Lille, France.
Neuropediatrics. 2023 Feb;54(1):68-72. doi: 10.1055/a-1896-6154. Epub 2022 Jul 11.
Various neurologic manifestations have already been described in children during or after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. The central nervous system disorders reported in children are mainly encephalopathies during multisystem inflammatory syndrome. We present here an acute meningoencephalitis with cerebral vasculitis associated to a coronavirus disease 2019 (COVID-19) infection in a 13-year-old girl with a 1-year clinical, electroencephalogram (EEG), and magnetic resonance imaging (MRI) follow-up.
A 13-year-old girl presented acute symptoms of consciousness impairment, frontal headache, hyperthermia, and aphasia, with moderate lymphopenia (900/mm), elevated C-reactive protein (17 mg/L), cerebrospinal fluid (CSF) pleocytosis (15 cells/mm), slow background with frontal focalization on EEG, a left frontal ischemic lesion, leptomeningeal enhancement, and bilateral limbic fluid-attenuated inversion recovery hyperintensity on cerebral MRI. Reverse transcription-polymerase chain reaction for SARS-CoV-2 was positive in nasopharyngeal swab and COVID serology was positive for immunoglobulin (Ig) M and G, whereas extensive autoimmune antibody investigation was negative except for a positive low titer of anti-myelin oligodendrocyte glycoprotein in CSF and blood. The diagnosis of probable encephalitis associated to cerebral vasculitis after COVID infection was suggested and steroids pulse were started. She recovered within a few days. Six months later, she had moderate clinical sequels including persistent intermittent headaches, an isolated spatial deficit, and focal spikes on the EEG without argument for epilepsia.
A teenager without previous medical history presented with acute encephalitis with leptomeningitis and vasculitis after a recent COVID-19 infection. Steroids pulse therapy allowed clinical improvement. Cerebral MRI and EEG helped diagnosis, follow-up of the encephalitis, and evolution after treatment.
在严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染期间或之后，儿童中已经描述了各种神经表现。在儿童中报告的中枢神经系统疾病主要是多系统炎症综合征期间的脑病。我们在此介绍了一例 13 岁女孩在冠状病毒病 2019（COVID-19）感染后出现急性脑膜脑炎伴脑血管炎，该女孩有 1 年的临床、脑电图（EEG）和磁共振成像（MRI）随访。
一名 13 岁女孩出现意识障碍、额头痛、高热和失语症的急性症状，伴有中度淋巴细胞减少症（900/mm）、C 反应蛋白升高（17mg/L）、脑脊液（CSF）细胞增多症（15 个细胞/mm）、EEG 显示额前局灶性慢背景、左侧额部缺血性病变、软脑膜增强和双侧边缘系统液体衰减反转恢复高信号。鼻咽拭子 SARS-CoV-2 的逆转录-聚合酶链反应为阳性，COVID 血清学 IgM 和 G 为阳性，而广泛的自身抗体检查除 CSF 和血液中抗髓鞘少突胶质细胞糖蛋白的低滴度阳性外均为阴性。提示 COVID 感染后可能与脑炎相关的血管炎，并开始使用类固醇脉冲治疗。她在几天内恢复。6 个月后，她有中度临床后遗症，包括持续性间歇性头痛、孤立的空间缺陷和 EEG 上的局灶性棘波，没有癫痫发作的证据。
一名无既往病史的青少年在最近感染 COVID-19 后出现急性脑膜脑炎伴脑膜炎和血管炎。类固醇脉冲治疗可改善临床症状。脑 MRI 和 EEG 有助于诊断、脑炎的随访以及治疗后的演变。
