MRI Shows Pediatric Stroke Case Associated with COVID-19

June 3, 2020

Iranian researchers diagnosed ischemic stroke in COVID-19-positive child with no other symptoms.

To date during the COVID-19 pandemic, neurologic manifestations in pediatric patients have not been frequently reported, but a team of researchers from Iran have published a case of pediatric stroke associated with the virus.

The team published their findings on June 2 in Radiology.

Based on the case study, a 12-year-old boy with no previous health issues was admitted to Razi Hospital with seizures. He was initially treated with diazepam, and he soon developed right-sided hemiparesis and dysarthria.

He had no fever, cough, shortness of breath, skin rash, hemoglobinopathy, or recent trauma, and he tested negative for herpes simplex 1 and 2, as well as varicella-zoster virus. Additionally, no one in his family had a history of COVID-19 infection.

“There were no symptoms of other systems involvement, cervical enlarged lymph nodes, cutaneous or mucosal rash, or redness,” according to the team, led by Seyed Mohammad Mousavi Mizaee, M.D., a neurologist at Razi Hospital in Birjand, Iran.

Using the RT-PCR test, the child was diagnosed with COVID-19 infection. His cerebrospinal fluid also tested positive for the virus. Most images, including low-dose lung CT, carotid color Doppler ultrasound, and echocardiography came back normal, but an MRI revealed findings that indicated stroke.

According to Mizaee’s team, there are many other possibilities that could cause a pediatric stroke, including arterial dissection, embolic or thrombotic stroke, cerebral vasculitis associated with systemic disease, including Kawasaki disease, and genetic disorders with arteriopathy. However, they contended, the most likely option and strongest diagnosis was that this patient’s stroke was caused by focal cerebral arteriopathy, one of the most common causes of childhood arterial ischemic stroke.

“Based on the patient’s history and lack of thrombotic processes outside the central nervous system, embolic stroke, and dissection were considered less likely than focal cerebral arteriopathy,” they wrote. “Recent reports of an elevated immune response and an inflammatory syndrome have been reported in children with COVID-19 infection.”

The patient had no signs of multi-system inflammatory syndrome or Kawasaki-like presentation, and the lumbar puncture for cerebrospinal fluid was not inflammatory.

Despite being discharged to home, the child is still experiencing right-side paralysis, the team reported.