*Important note: search apron It publishes preliminary scientific reports that have not been peer-reviewed and therefore should not be considered conclusive, directing clinical practice/health-related behaviour, or treated as hard information.In a recent study published in search field * Preprint server, an international team of researchers is reviewing current literature to understand the relationship between SARS-CoV-2 infection, severe acute respiratory syndrome, abnormal neuroimaging manifestations, and neurological symptoms among individuals younger than 18 years of age.
Stady: Association of SARS-CoV-2 infection with neurological symptoms and neuroimaging manifestations in children: a systematic review. Image credit: alekso94/Shutterstock.com
background
The clinical presentation of coronavirus disease 2019 (COVID-19) varies widely among individuals, ranging from asymptomatic or mild cases to severe cases involving acute respiratory distress syndrome (ARDS), pneumonia and multi-organ complications.
Emerging evidence indicates that thrombotic interactions and Cellular storm that develop during acute COVID-19 contribute to psychiatric and neurological complications, with a high incidence of intracerebral hemorrhage and stroke.
While several studies have investigated neurological complications associated with acute SARS-CoV-2 infection in adults, manifestations of COVID-19 among children have been largely asymptomatic or mild and do not require hospitalization.
However, emerging evidence suggests that systemic symptoms such as secondary inflammatory responses, collectively known as Multisystem inflammatory syndrome in children (MIS-C), among children with severe COVID-19. While rare, MIS-C is associated with a high incidence of neuroimaging abnormalities and neurological complications. However, the extent of central nervous system (CNS) complications associated with SARS-CoV-2 infection in children remains unclear.
about studying
In this study, researchers review the peer-reviewed literature on neurological symptoms and abnormalities during neuroimaging associated with COVID-19 in individuals younger than 18 years of age with laboratory-confirmed SARS-CoV-2 infection. The studies reviewed included case-control studies, case reports, experimental studies, observational studies, cohort studies, clinical trials, randomized control trials, and other types of study designs.
The results of the studies reviewed included computed tomography (CT), positron emission tomography (PET), magnetic resonance imaging (MRI), or neuroimaging through other modalities.
Studies involving unconfirmed SARS-CoV-2 infection or individuals with previous neurological comorbidities were performed on animal models only, or did not contain explicit reporting of neurological examination results or cognitive assessments, and dissertations, abstracts, review articles, and perspective papers were excluded. guidelines and editorials.
Data from these studies were analyzed according to various criteria, including the severity of COVID-19, the number of children infected with SARS-CoV-2 who showed neurological symptoms or abnormalities on neuroimaging examinations, as well as the type and time of occurrence of neurological complications.
results
While children, in general, experienced milder infections from SARS-CoV-2, 19 studies reported that 12.8% of children who experienced severe COVID-19 requiring hospitalization had neurocognitive impairments.
Of the patients who showed neurological abnormalities, 24.2% had MIS-C, 10.1% had neuroinflammatory manifestations such as acute disseminated encephalomyelitis, myelitis, encephalitis, meningitis, or meningitis, and 8.1% suffer from encephalopathy.
Symptoms such as muscle weakness and drowsiness were more common among children than among adolescents. The children also showed more irritability and irritability than the infants.
The neuroprotective capabilities of SARS-CoV-2, in which the virus uses the angiotensin-converting enzyme 2 (ACE-2) receptor to enter neurons, is one putative mechanism by which COVID-19 is thought to cause neurological complications in the pediatric population.
Neuropathy is believed to disrupt intracellular neurobalance and the blood-brain barrier, which ultimately leads to inflammation. Inflammatory manifestations could also explain the predominant symptoms of seizures and headaches that are commonly reported in several studies.
Entry of SARS-CoV-2 through the olfactory tract or ACE-2 receptors may also disrupt the blood-brain barrier, thus exposing the immune system to antigens from the central nervous system.
Researchers also discussed similarities between COVID-19 and disorders related to demyelination, such as Guillain-Barré syndrome. Neuromolecular mimicry of COVID-19 antigenic factors may enable interactions between SARS-CoV-2 and endogenous myelinogens to eventually cause neuronal damage.
One study that explored persistent complaints of functional impairments among adolescent COVID-19 patients reported that PET scans depicted a pattern of hypermetabolism in the medial temporal lobe and olfactory gyrus that extended into the cerebellum and pons. Similar results have been observed in longtime COVID patients.
conclusions
Although the manifestations of COVID-19 were largely mild among children and adolescents, a significant proportion of pediatric COVID-19 patients experienced MIS-C. Moreover, manifestations of encephalopathy and polyneuritis were moderately common among these patients.
There is still an urgent need for more longitudinal studies to understand the age-related variability of neurological complications associated with COVID-19 in children.
*Important note: search apron It publishes preliminary scientific reports that have not been peer-reviewed and therefore should not be considered conclusive, directing clinical practice/health-related behaviour, or treated as hard information.
