Çocuklarda Multisistem İnflamatuvar Sendromun Nörolojik Bulguları

Abstract

Ilk olarak Londra’nın güneydoğusunda bildirilen çocuklarda COVID-19 ile ilişkili multisistem inflamatuar sendromun (MIS-C) nörolojik bulguları baş ağrısı, bilinç değişikliği, aseptik menenjit, ensefalit, nöbet, ataksi ve inme gibi geniş bir nörolojik belirti ve semptom yelpazesine sahiptir. Bu hastalara mümkün olan en kısa sürede tanı koymak ve multidisipliner bir yaklaşımla tedavi etmek önemlidir. Nörolojik semptomları olan ve çoğu nörolojik açıdan düzelme gösteren MIS-C hastalarında taburculuk sonrası takip ile ilgili az sayıda çalışma vardır. MIS-C’ye bağlı gelişmesi olası nörolojik sekelleri belirlemek için uzun vadeli takip gerekmektedir.

Keywords

• COVID-19
• MIS-C
• nörolojik bulgular

Neurological Manifestations of Multisystem Inflammatory Syndrome in Children

Abstract

Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) first reported from South East London has a wide spectrum of neurological signs and symptoms including headache, impaired consciousness, aseptic meningitis, encephalitis, seizure, ataxia and stroke. It is important to diagnose these patients as soon as possible and treat them with a multi-disciplinary approach. A few studies have reported posthospital discharge follow-up data in MIS-C patients with neurological symptoms most of which showed neurological improvement, however, long-term follow-up will be required to determine any sequelae of MIS-C on neurological functions.

Keywords

• COVID-19
• MIS-C
• Neurological manifestations

References

1. 1)Das G, Mukherjee N, Ghosh S. Neurological Insights of COVID-19 Pandemic. ACS Chem Neurosci 2020;11:1206-09.
2. 2)Reichard RR, Kashani KB, Boire NA, Constantopoulos E, Guo Y, Lucchinetti CF. Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology. Acta Neuropathol 2020;140:1-6. 
3. 3)Baig AM, Khaleeq A, Ali U, Syeda H. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host−Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chem Neurosci 2020;11:995-8.
4. 4) Lin JE, Asfour A, Sewell TB, Hooe B, Pryce P, Earley C, et al. Neurological Issues in Children with COVID-19. Neurosci Lett 2020 ;743:135567.
5. 5)Zubair AS, McAlpine LS, Gardin T, Farhadian S, Kuruvilla DE, Spudich S. Neuropathogenesis and Neurologic Manifestations of the Coronaviruses in the Age of Coronavirus Disease 2019: A Review. JAMA Neurol 2020;77:1018-1027.
6. 6)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: 1–9.
7. 7)Pinna P, Grewal P, Hall JP, Tavarez T, Dafer RM, Garg R et al. Neurological manifestations and COVID-19: experiences from a tertiary care center at the frontline. J. Neurol. Sci 2020; 415: 116969.
8. 8)Pezzini A, Padovani A. Lifting the mask on neurological manifestations of COVID-19. Nat Rev Neurol 2020;16: 636–644.

9. 9)Stafstrom CE, Jantzie LL. COVID-19: Neurological Considerations in Neonates and Children. Children (Basel) 2020;7: 133.
10. 10)Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020 ;395:1607-1608.
11. 11)Licciardi F, Pruccoli G, Denina M, Parodi E, Taglietto M, Rosati S, et al. SARS-CoV2-induced Kawasaki-like hyperinflammatory syndrome: a novel COVID phenotype in children. Pediatrics 2020;146:20201711.
12. 12)Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020;395:1771–1778.
13. 13)Cheung EW, Zachariah P, Gorelik M, Boneparth A, Kernie SG, Orange JS, et al. Multisystem inflammatory syndrome related to COVID-19 in previously healthy children and adolescents in New York City. JAMA 2020 ;324:294-296.
14. 14)Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K, et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine 2020;26:100527.
15. 15)Centers for Disease Control and Prevention. Emergency preparedness and response: health alert network. Available from: emergency.cdc.gov/han/ 2020/han00432.asp . Accessed August 5, 2020.
16. 16) World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19. Available from: www.who.int/publicationsdetail/multisystem-inflammatory-syndrome-in-children-and-adolescents-withcovid-19. Accessed August 5, 2020.
17. 17) Rowley AH. Understanding SARS-CoV-2-related multisystem inflammatory syndrome in children, Nat Rev Immunol 2020;20:453-454. 
18. 18) Weisberg SP, Connors T, Zhu Y, Baldwin M, Lin WH, Wontakal S, et al. Antibody responses to SARS-CoV2 are distinct in children with MIS-C compared to adults with COVID-19. medRxiv 2020 Jul 14;2020.07.12.20151068. 
19. 19)Chen TH. Neurological involvement associated with COVID-19 infection in children. J Neurol Sci 2020;418:117096.
20. 20)Kaushik S, Gupta M, Sood S, Sharma S, Verma A. Systematic Review of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection, Pediatr Infect Dis J 2020 ;39:e340-346.
21. 21) 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 ;77:1-6.
22. 22)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 SARSCoV-2. JAMA 2020 21;324:259-269.
23. 23) Chiotos K, Bassiri H, Behrens EM, Blatz AM, Chang J, Diorio C, et al. Multisystem inflammatory syndrome in children during the coronavirus 2019 pandemic: a case series. J Pediatric Infect Dis Soc 2020;9:393–8.
24. 24) Abel D, Shen MY, Abid Z, Hennigan C, Boneparth A, Miller EH, et al. Bain, Encephalopathy and bilateral thalamic lesions in a child with MIS-C associated with COVID-19, Neurology 2020 ;95:745-748. 
25. 25) Verkuil LD, Liu GT, Brahma VL, Avery RA. Pseudotumor cerebri syndrome associated with MIS-C: a case report. Lancet 2020 ;396:532. 
26. 26) Jiang L, Tang K, Levin M, Irfan O, Morris SK, Wilson K, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis. 2020 ;20:e276-e288.