Department of Radiology, Hunan Children's Hospital, No. 86 Ziyuan Road, 410007, Changsha, Hunan, China.
Department of Neurology, Hunan Children's Hospital, No. 86 Ziyuan Road, 410007, Changsha, Hunan, China.
J Neurovirol. 2024 Apr;30(2):187-196. doi: 10.1007/s13365-024-01202-1. Epub 2024 Apr 3.
Apart from the typical respiratory symptoms, coronavirus disease 2019 (COVID-19) also affects the central nervous system, leading to central disorders such as encephalopathy and encephalitis. However, knowledge of pediatric COVID-19-associated encephalopathy is limited, particularly regarding specific subtypes of encephalopathy. This study aimed to assess the features of COVID-19-associated encephalopathy/encephalitis in children. We retrospectively analyzed a single cohort of 13 hospitalized children with COVID-19-associated encephalopathy. The primary outcome was the descriptive analysis of the clinical characteristics, magnetic resonance imaging and electroencephalography findings, treatment progression, and outcomes. Thirteen children among a total of 275 (5%) children with confirmed COVID-19 developed associated encephalopathy/encephalitis (median age, 35 months; range, 3-138 months). Autoimmune encephalitis was present in six patients, acute necrotizing encephalopathy in three, epilepsy in three, and central nervous system small-vessel vasculitis in one patient. Eight (62%) children presented with seizures. Six (46%) children exhibited elevated blood inflammatory indicators, cerebrospinal fluid inflammatory indicators, or both. Two (15%) critically ill children presented with multi-organ damage. The magnetic resonance imaging findings varied according to the type of encephalopathy/encephalitis. Electroencephalography revealed a slow background rhythm in all 13 children, often accompanied by epileptic discharges. Three (23%) children with acute necrotizing encephalopathy had poor prognoses despite immunotherapy and other treatments. Ten (77%) children demonstrated good functional recovery without relapse. This study highlights COVID-19 as a new trigger of encephalopathy/encephalitis in children. Autoimmune encephalitis is common, while acute necrotizing encephalopathy can induce poor outcomes. These findings provide valuable insights into the impact of COVID-19 on children's brains.
除了典型的呼吸道症状外，2019 年冠状病毒病（COVID-19）还会影响中枢神经系统，导致脑病和脑炎等中枢疾病。然而，儿童 COVID-19 相关脑病的知识有限，特别是关于脑病的具体亚型。本研究旨在评估儿童 COVID-19 相关脑病/脑炎的特征。我们回顾性分析了一组 13 例住院 COVID-19 相关脑病患儿。主要结局是对临床特征、磁共振成像和脑电图表现、治疗进展和结局进行描述性分析。在总共 275 例确诊 COVID-19 的患儿中，有 13 例（5%）发生了相关脑病/脑炎（中位年龄 35 个月；范围 3-138 个月）。自身免疫性脑炎 6 例，急性坏死性脑病 3 例，癫痫 3 例，中枢神经系统小血管炎 1 例。8 例（62%）患儿出现癫痫发作。6 例（46%）患儿表现为血炎性指标、脑脊液炎性指标或两者均升高。2 例（15%）危重症患儿表现为多器官损伤。磁共振成像表现根据脑病/脑炎的类型而有所不同。所有 13 例患儿的脑电图均显示背景节律减慢，常伴有癫痫样放电。尽管进行了免疫治疗和其他治疗，3 例（23%）急性坏死性脑病患儿预后较差。10 例（77%）患儿功能恢复良好，无复发。本研究强调 COVID-19 是儿童脑病/脑炎的新触发因素。自身免疫性脑炎常见，而急性坏死性脑病可导致不良结局。这些发现为 COVID-19 对儿童大脑的影响提供了有价值的见解。
