Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, 1003, Lebanon.
School of Pharmacy (Department of Biomedical Sciences), Lebanese International University, Mazraa, 146404, Lebanon.
Sci Rep. 2024 Feb 27;14(1):4790. doi: 10.1038/s41598-024-55597-2.
The COVID-19 pandemic has impacted individuals differently, and there's been a growing body of evidence pointing to neurological complications caused by the virus. However, our understanding of the range of neurological issues linked to SARS-CoV-2 infection in children is limited. This systematic review and meta-analysis aimed to assess the abnormal neuroimaging findings in pediatric COVID-19 patients, shedding light on this crucial aspect of the disease's impact on children. We conducted an extensive search in the PubMed, Medline, and ScienceDirect databases for observational studies reporting neuroimaging findings of the brain and spinal cord in children with COVID-19 between December 1, 2019, and October 30, 2021. Grey literature sources, including medRxiv and Google Scholar, were also explored. Pooled proportions of abnormal neuroimaging findings, categorized into neurovascular findings, ADEM-like lesions, encephalitic pattern, myelitis, transient splenial lesions, and other anomalies, were calculated using a random-effects model. Between-study heterogeneity was assessed using the χ statistic for pooled proportions and the inconsistency index I. The Quality of the studies was evaluated using the NIH Quality Assessment Tool and the adapted Newcastle-Ottawa Scale. Our search yielded 9,605 articles, with 96 studies (involving 327 pediatric patients) included in the qualitative analysis. Of these, five reports (encompassing 111 patients) underwent quantitative analysis. The pooled proportion of pediatric COVID-19 patients with neurological symptoms and exhibiting abnormal neuroimaging findings was 43.74%. These findings were further categorized into neurovascular findings (8.22%), ADEM-like lesions (7.69%), encephalitic pattern (13.95%), myelitis (4.60%), transient splenial lesions (16.26%), and other abnormalities (12.03%). Insignificant between-study heterogeneity was observed in all categories, and our analysis did not reveal significant publication bias. In conclusion, a substantial proportion of pediatric COVID-19 patients with neurological symptoms have abnormal neuroimaging findings, underscoring the need for vigilant monitoring of neurological complications in this vulnerable population. Standardized reporting and long-term follow-up studies are essential to fully understand the implications of these findings. Collaborative research efforts will deepen our understanding of COVID-19's neurological dimensions in children and enhance clinical care for this population.
新型冠状病毒肺炎（COVID-19）疫情对个体的影响各不相同，越来越多的证据表明，该病毒可引起神经系统并发症。然而，我们对儿童感染严重急性呼吸综合征冠状病毒 2 型（SARS-CoV-2）相关神经系统问题的范围的了解是有限的。本系统评价和荟萃分析旨在评估儿科 COVID-19 患者异常神经影像学表现，阐明该疾病对儿童影响的这一关键方面。我们在 PubMed、Medline 和 ScienceDirect 数据库中进行了广泛搜索，以查找 2019 年 12 月 1 日至 2021 年 10 月 30 日期间报道儿童 COVID-19 患者脑和脊髓神经影像学表现的观察性研究。还探索了灰色文献来源，包括 medRxiv 和 Google Scholar。使用随机效应模型计算异常神经影像学发现的汇总比例，分为神经血管发现、类似急性播散性脑脊髓炎病变、脑炎样模式、脊髓炎、短暂性脑桥病变和其他异常。使用 χ²统计量评估汇总比例的组间异质性和不一致性指数 I。使用 NIH 质量评估工具和改编的 Newcastle-Ottawa 量表评估研究质量。我们的检索共得到 9605 篇文章，纳入 96 项研究（涉及 327 例儿科患者）进行定性分析。其中，5 项研究报告（共 111 例患者）进行了定量分析。有神经系统症状且表现出异常神经影像学表现的儿科 COVID-19 患者的汇总比例为 43.74%。这些发现进一步分为神经血管发现（8.22%）、类似急性播散性脑脊髓炎病变（7.69%）、脑炎样模式（13.95%）、脊髓炎（4.60%）、短暂性脑桥病变（16.26%）和其他异常（12.03%）。所有类别均观察到组间异质性无显著性，且分析未发现显著的发表偏倚。总之，有神经系统症状的儿科 COVID-19 患者中相当大比例存在异常神经影像学表现，这突显了在这一脆弱人群中需警惕监测神经系统并发症的必要性。标准化报告和长期随访研究对于全面了解这些发现的意义至关重要。协作研究将加深我们对儿童 COVID-19 神经系统方面的理解，并改善对该人群的临床护理。
