Multisystem Inflammatory Syndrome in a Child Presenting with Acute Hemiparesis as a Rare Neurologic Manifestation

Abstract

Coronavirus pandemic has become one of the most important illness affecting all over the world and causing the death of millions of people. Because it started at the end of 2019 it named as coronavirus disease-2019 (COVID-19). Multisystem inflammatory syndrome in children (MIS-C), which is a new disease definition, that has emerged as a result of the COVID-19 pandemic. Although it is known that MIS-C causes many different symptoms, our knowledge will increase exponentially as more articles and case reports continue to published to the literature. Although MIS-C affects many systems, various neurological involvement has also been reported. But, according to literature, no case with hemiparesis in MIS-C has been reported so far. To the best of our knowledge this is the case presenting with hemiparesis without intracranial pathology in the diagnosis of MIS-C.

Keywords

• acute hemiparesis
• child
• COVID-19
• MIS-C
• neurologic manifestation

Nadir Bir Nörolojik Bulgu Olarak Akut Hemiparezi ile Başvuran Çocukta Multisistem İnflamatuar Sendrom

Abstract

Koronavirüs pandemisi tüm dünyayı etkisi altına alan ve milyonlarca insanın ölümüne neden olan en önemli hastalıklardan biri haline geldi. 2019 yılının sonunda başladığı için koronavirüs hastalığı-2019 (COVID-19) olarak adlandırılmıştır. COVID-19 pandemisi sonucu ortaya çıkan, yeni bir hastalık tanımı olan çocuklarda multisistem inflamatuar sendrom (MIS-C). MIS-C'nin birçok farklı semptoma neden olduğu bilinmesine rağmen, literatürde daha fazla makale ve vaka sunumu yayınlandıkça bilgimiz katlanarak artacaktır. MIS-C birçok sistemi etkilemekle birlikte çeşitli nörolojik tutulumlar da bildirilmiştir. Ancak literatüre göre şimdiye kadar MIS-C'de hemiparezisi olan bir olgu bildirilmemiştir. Bildiğimiz kadarıyla MIS-C tanısında intrakraniyal patoloji olmaksızın hemiparezi ile başvuran nadir bir olgudur.

Keywords

• akut hemiparezi
• çocuk
• COVID-19
• MIS-C
• nörolojik belirtiler

References

1. Martins MM, Prata-Barbosa A, Ledo Alves da Cunha AJ. Update on SARS-CoV-2 infection in children. Paediatrics and International Child Health 2021;41;56-64.
2. Panigrahy N, Policarpio J, Ramanathan R. Multisystem inflammatory syndrome in children and SARS-CoV-2: A scoping review. Pediatr Rehabil Med 2020;13:301-16.
3. Loke Y-HY-H, Berul CICI, Harahsheh ASAS. Multisystem inflammatory syndrome in children: is there a linkage to Kawasaki disease? Trends Cardiovasc Med 2020; 30: 389–96.
4. Information for Healthcare Providers about Multisystem Inflammatory Syndrome in Children (MIS-C) | CDC. Full text: https://www.cdc.gov/mis-c/hcp/ (accessed 12 August 2020).
5. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020; 395: 1607–8.
6. Licciardi F, Pruccoli G, Denina M, Parodi E, Taglietto M, Rosati S, et al. SARS-CoV-2-Induced Kawasaki-Like Hyperinflammatory Syndrome: A Novel COVID Phenotype in Children. Pediatrics 2020;146: e20201711.
7. Romero-Sánchez CM, Díaz-Maroto I, Fernández-Díaz E. Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry. Neurology 2020;95:1060-70.
8. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol 2020;77:683-90.

9. Panda PK, Sharawat IK, Panda P, Natarajan V, Bhakat R, Dawman L. Neurological Complications of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis. J Trop Pediatr 20201; 67:fmaa070.
10. Susanna Esposito, Nicola Principi. Multisystem Inflammatory Syndrome in Children Related to SARS-CoV-2. Pediatric Drugs 2021;23:119–29.
11. Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, et al. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med 2020;383:347-58.
12. Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, et al. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA 2020;324:259-69.
13. Kaushik A, Gupta S, Sood M, Sharman S, Verma S. A Systematic Review of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection. Pediatr Infect Dis J 2020;39:340-6. 
14. Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J, et al. A. Multi-system inflammatory syndrome in children&adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev 2020;38: 51-7.
15. Cirks BT, Rowe SJ, Jiang SY, Brooks R, Mulreany MP, Hoffner W, et al. 16 Weeks Later: Expanding the Risk Period for MIS-C. J Pediatric Infect Dis Soc 2021;10: 686–90.
16. Abdel-Mannan O, Eyre M, Löbel U, Bamford A, Eltze C, Hameed B, et al. Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children. JAMA Neurol 2020;77:1440-5.
17. LaRovere KL, Riggs BJ, Poussaint TY, Yonug CC, Newhams MM, Maamari M, et al. Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome. JAMA Neurol 2021;78:536-47.
18. Sa M, Mirza L, Carter M, Carlton Jones L, Gowda V, Handforth J, et al. Study Group. Systemic Inflammation Is Associated With Neurologic Involvement in Pediatric Inflammatory Multisystem Syndrome Associated With SARS-CoV-2. Neurol Neuroimmunol Neuroinflamm 2021 13;8:e999.
19. Chinnabhandar V, Singh A, Mandal A, Parmar BJ. Acute Hemiplegia in Children: A Prospective Study of Etiology, Clinical Presentation, and Outcome from Western India. J Neurosci Rural Pract 2018;9:504-9.
20. Nandyala A, Shah T, Ailani J. Hemiplegic Migraine. Curr Neurol Neurosci Rep 2023 ;23:381-7.