Introduction

Since the emergence of COVID-19, we have experienced potent variants and sub-variants of the virus with non-specific neurological manifestations. We observed a surge of the Omicron variant of COVID-19 patients with neurological manifestations where less cases of multisystem inflammatory syndrome in children (MIS-C) were reported. This article describes our experience of children with severe and rare neurological manifestations following COVID-19 infection.

Methods

This is a retrospective observational case series of patients under 18 years old who fulfilled the WHO COVID-19 case definition and were referred to our paediatric neurology unit at Hospital Tunku Azizah Kuala Lumpur. Their demographic data, neurological symptoms, laboratory and supporting investigations, neuroimaging, treatment and outcomes were collected and analysed.

Results

There were eleven patients with neurological manifestations who fulfilled the WHO COVID-19 case definition. Nine patients presented with seizures and/or encephalopathy, one patient with eye opsoclonus and another patient with persistent limbs myokymia. Based on the history, clinical, electrophysiological and radiological findings, two of them had febrile infection-related epilepsy syndrome, two had acute disseminated encephalomyelitis, two had acute necrotising encephalopathy of childhood, one each had hemiconvulsion-hemiplegia-epilepsy syndrome, acute encephalopathy with bilateral striatal necrosis, hemi-acute encephalopathy with biphasic seizures and reduced diffusion, infection-associated opsoclonus and myokymia.

Conclusions

This case series highlighted a wide spectrum of neurological manifestations of COVID-19 infection. Early recognition and prompt investigations are important to provide appropriate interventions. It is essential that these investigations should take place in a timely fashion and COVID-19 quarantine period should not hinder the confirmation of various presenting clinical syndromes.

中文翻译：

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儿童感染 COVID-19 后出现严重和罕见的神经系统症状：马来西亚三级中心的经验

介绍

自 COVID-19 出现以来，我们经历了具有非特异性神经系统表现的病毒强变体和亚变体。我们观察到 Omicron 变种的 COVID-19 患者出现神经系统表现的激增，其中儿童多系统炎症综合征 (MIS-C) 病例的报告较少。本文介绍了我们对感染 COVID-19 后出现严重和罕见神经系统症状的儿童的经历。

方法

这是一个回顾性观察病例系列，对象是 18 岁以下的患者，这些患者符合 WHO COVID-19 病例定义，并被转诊至吉隆坡东姑阿齐莎医院的儿科神经科。收集并分析了他们的人口统计数据、神经系统症状、实验室和支持调查、神经影像学、治疗和结果。

结果

有 11 名出现神经系统表现的患者符合 WHO COVID-19 病例定义。九名患者出现癫痫发作和/或脑病，一名患者出现眼阵挛，另一名患者出现持续性四肢肌颤。根据病史、临床、电生理和放射学检查结果，其中两人患有发热性感染相关性癫痫综合征，两人患有急性播散性脑脊髓炎，两人患有儿童急性坏死性脑病，各一人患有偏侧惊厥-偏瘫-癫痫综合征，急性脑病双侧纹状体坏死、伴有双相癫痫发作和扩散减少的半急性脑病、感染相关的视阵挛和肌颤搐。

结论

该病例系列强调了 COVID-19 感染的广泛神经系统表现。早期识别和及时调查对于提供适当的干预措施非常重要。重要的是，这些调查应及时进行，并且 COVID-19 隔离期不应妨碍对各种临床症状的确认。