背景在科学文献中,世界各地越来越多地报道了2019年冠状病毒病(COVID-19)儿科患者的各种神经系统表现。目的评价我院收治的COVID-19感染患儿的神经症状及神经影像学表现。材料与方法在3个月内有COVID-19感染实验室证据和急性神经系统表现的0至12岁儿童,接受过磁共振成像(MRI)的患者被纳入研究.我们根据神经系统的发现将它们分为四组:急性脑炎综合征(AES),急性弛缓性麻痹(AFP),脑血管事件/中风,和杂项包括无脑病的急性癫痫发作。结果共纳入19例与COVID-19感染相关的神经系统表现患儿。AES是最常见的神经系统综合征,占47.36%,其次是26.31%的AFP和21.05%的心血管事件/卒中。癫痫发作是最常见的神经系统症状,占62.15%,其次是脑病42.10%和AFP26.31%。在神经影像学上,观察到的模式是免疫介导的马尾神经根增强26.31%或急性播散性脑炎5.26%,小的急性梗塞,海马,双侧丘脑信号变化各21.05%,15.78%的微出血和白质脑病,合并感染占5.26%。结论在我们的研究中,癫痫发作和脑病是COVID-19感染最常见的神经系统症状。感染后免疫介导的马尾神经根增强或急性脱髓鞘性脑脊髓炎样脑成像,其次是小的急性梗死和海马/丘脑信号改变是最常见的影像学模式。我们在许多儿童中发现了重叠的神经和MRI模式,表明各种病理生理机制单独或协同作用。
Background Varied neurological manifestations in pediatric patients with coronavirus disease 2019 (COVID-19) have been increasingly reported from all across the world in the scientific literature. Objective We aimed to evaluate pediatric cases with neurological symptoms and neuroimaging findings with COVID-19 infection in our hospital. Materials and Methods Children from 0 to 12 years with laboratory evidence of COVID-19 infection and acute neurological manifestations within 3 months, who have undergone magnetic resonance imaging (MRI) were included in the
study. We categorized them based on neurological findings into four groups: acute encephalitis syndrome (AES), acute flaccid paralysis (AFP), cerebrovascular event/stroke, and miscellaneous consisting of acute seizures without encephalopathy. Results A total of 19 children with neurological manifestations related to COVID-19 infection were included in the
study. AES was the most common neurological syndrome seen in 47.36%, followed by AFP in 26.31% and cardiovascular event/stroke in 21.05%. Seizure was the most common neurological symptoms in 62.15%, followed by encephalopathy in 42.10% and AFP in 26.31%. On neuroimaging, pattern observed were immune-mediated cauda equina nerve roots enhancement in 26.31% or acute disseminated encephalitis in 5.26%, small acute infarcts, hippocampal, and bilateral thalamic signal changes seen in 21.05% each, microhemorrhages and
leukoencephalopathy in 15.78%, and coinfection in 5.26%. Conclusion In our
study, seizures and encephalopathy were the most common neurological symptoms with COVID-19 infection. Postinfectious immune-mediated cauda equina nerve root enhancement or acute demyelinating encephalomyelitis-like brain imaging, followed by small acute infarcts and hippocampal/thalamic signal changes were most common imaging patterns. We found overlapping neurological and MRI patterns in many children, suggesting that various pathophysiological mechanisms act individually or synergistically.