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July 28, 2022
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November 27, 2022
Published
November 10, 2024
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Abstract

Importance: The effects of COVID-19 on the neurological system warrants recognition in our paediatric population. The long-term effects on development should be closely monitored, especially if autoimmunity is suspected. 


Objective: To present paediatric cases of unusual neuroinflammatory conditions encountered during the COVID-19 pandemic in Trinidad & Tobago.


Design: Observational cross-sectional study.


Setting: Hospital – Eric Williams Medical Sciences Complex.


Participants: Inpatient encounters involving paediatric patients (aged 0-16 years) and hospitalized for neurological complaints during the period June 2020 – August 2021.


Exposure: COVID-19/SARS-CoV-2 virus


Main Outcomes: Age, gender, ethnicity, diagnosis, radiological findings, blood and CSF findings, COVID-19 status, treatment, outcomes and other systems involved.


Results: Twenty (20) patients (aged 4-months-old to 15-years-old) had documented neurological involvement. 50% (n=10) had a diagnosis of ADEM/ADS/AHNE; 45% had a diagnosis of either CNS vasculitis (n=3), autoimmune encephalitis (n=3) or GBS (n=3); 5% (n=1) had a diagnosis of acute COVID-19 encephalitis. 70% (n=14) were of African descent. The youngest age group (0-4 years) (n=11) constituted more males (82%) while the eldest age group (10-15 years) (n=3) were all females. Neuroimaging findings were corpus callosal lesions; deep white matter T2 hyperintensities; cerebellar involvement; area postrema and brainstem/C-spine involvement; microhaemorrhages and necrotizing/haemorrhagic lesions (peripheral/central). 70% of patients (n=14) were either SARS-CoV-2 PCR positive or COVID-19 antibodies positive. 40% (n=8) had other systemic inflammatory involvement – Of this specific cohort, 62.5% (n=5) had cardiac involvement (myocarditis, coronary arteries dilatation, valve regurgitation) and 37.5% (n=3) had pancreatic involvement (autoimmune pancreatitis, type 1 diabetes mellitus). Treatment modalities for CNS manifestations (n=17) were clinically based – 24% (n=4) 3rd line treatment, 29% (n=5) 2nd line treatment, 41% (n=7) 1st line treatment and 6% (n=1) requiring no treatment. All 3 patients with a diagnosis of GBS responded appropriately to IVIG. Outcomes were worse in patients with a diagnosis of autoimmune encephalitis and positive ANA.


Conclusion/Relevance: There has been an upsurge in neuro-inflammatory cases since the COVID-19 pandemic began. The range of neuroradiological diagnoses and other systemic involvement (including meeting criteria for PIMS/MIS-C) alludes to a neuroinflammatory mechanism. Effects on long-term sequelae and developmental outcomes are concerning, however, at this early stage, still unknown.

Keywords

ADEM COVID-19 GBS AHNE Demyelinating disorders Neuro-inflammatory

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Copyright (c) 2024 Vanita Shukla MD, Paramanand Maharaj MD, Vindra A Singh MD, Leonardo Akan MD, Nicle Solomon MD, Ronand Ramroop MD, Sunil Latchman MRCPCH, Nelicia Cooke MBBS, Giselle Pierre MD, Cara Ranghell MD, Sushil Devarashetty MD, Elizabeth Persad MD, Kevin Khan-Kernahan MD, Virendra R S Singh MD, Maritza Fernandes MD

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How to Cite
Shukla, V., Maharaj , P., Singh , V. A., Akan, L., Solomon , N., Ramroop , R., … Fernandes, M. (2024). Unusual neurological manifestations in children during the COVID-19 pandemic: a cross-sectional study in Trinidad & Tobago. Journal of the International Child Neurology Association, 1(1). https://doi.org/10.17724/jicna.2024.252
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