1/ MRI study -Prev healthy kids now with COVID19 - Short thread

Largest study to date of CNS Imaging features -

Cases grouped based on clinical data. 4 groups
1. Acute Covid19
2. Asymptomatic or subacute Covid19 inf
3. MIS-C
4. Indeterminate with neuro sympt and #sarscov2 inf https://twitter.com/LancetChildAdol/status/1339149705125785601

2/ Autoimmune type, diffuse changes, the white stuff in image, probable edema and inflammation.

3/ Two kids had myelitis, with one kid having tissue death in due to necrotizing myelitis. 2 other kids had also cranial nerve neuritis.

4/ Also 1 child demonstrated 3rd cranial nerve involvement and cauda equina - loss of autonomic function i.e. no bladder and sphincter control.

5/ Co-infections with fever and seizures. Kids got Covid19 diagnosis, no other signs and were well. Later ensued co-infection with Tuberculosis in 2, Strep constell + fuso bact necroph 1 case and 1 case with VZV+MRSA-

All these cases prev. well, died in their co-infection.

6/ Asymp group - similar to acute covid19. 1 child remains ventilated since 6 months. Rest are doing fine.

7/ Children with MIS-C or Kawasaki-like syndrome
Presented with inflammation in the muscles of the neck, myositis. Also had T2signal changes in the splenium of Corpus Callosum - one of the main links of white matter between the two brain halves. All children recouperated.

8/ The last group with diffuse symptoms had multiple engagements on cranial nerves. 1 child had a stroke, left midbrain infarction, Thrombus in Anterior Perforator Artery.

9/ Summary

ADEM-like pattern abnormalities emerged with multiple cranial nerve involvement; neuritis. Cerebrovascular insults less frequent than reported in adults, cranial nerve involvement could show up on MRI without clinical symptoms i.e sensory+motor from these nerves.

10/ Of particular note :

COVID19 co-infections may be a major factor to pay attention to due to evident mortality risk in this study.

P.S
Sweden did not partake in study. Over 70 kids have MIS-C in Sweden.

Here is the study. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30362-X/fulltext

@DrKatrin_Rabiei @ViralRNA @angie_rasmussen @MackayIM @DrIanWeissman @itosettiMD_MBA @PascalJabbourMD @auscandoc @Diana_Jaalouk @florian_krammer

Maybe of particular interest to you. Linked Lancet study #10 slide/tweet. Stay well.