Acute disseminated encephalomyelitis in a COVID-19 pediatric patient
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Acute disseminated encephalomyelitis in a COVID-19 pediatric patient Adélia Maria de Miranda Henriques-Souza 1 & Ana Cláudia Marques Gouveia de Melo 1 & Bianca de Aguiar Coelho Silva Madeiro 2 & Leonardo Furtado Freitas 4 & Pedro Augusto Sampaio Rocha-Filho 2,3 Fabrício Guimarães Gonçalves 5
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Received: 29 June 2020 / Accepted: 23 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The authors present a case of acute disseminated encephalomyelitis in a COVID-19 pediatric patient with positive SARS-CoV2 markers from a nasopharyngeal swab. A previously healthy 12-year-old-girl presented with a skin rash, headache, and fever. Five days after that, she had an acute, progressive, bilateral, and symmetrical motor weakness. She evolved to respiratory failure. Magnetic resonance imaging (MRI) of the brain and cervical spine showed extensive bilateral and symmetric restricted diffusion involving the subcortical and deep white matter, a focal hyperintense T2/ FLAIR lesion in the splenium of the corpus callosum with restricted diffusion, and extensive cervical myelopathy involving both white and gray matter. Follow-up examinations of the brain and spine were performed 30 days after the first MRI examination. The images of the brain demonstrated mild dilatation of the lateral ventricles and widespread widening of the cerebral sulci, complete resolution of the extensive white matter restricted diffusion, and complete resolution of the restricted diffusion in the lesion of the splenium of the corpus callosum, leaving behind a small gliotic focus. The follow-up examination of the spine demonstrated nearly complete resolution of the extensive signal changes in the spinal cord, leaving behind scattered signal changes in keeping with gliosis. She evolved with partial clinical and neurological improvement and was subsequently discharged. Keywords COVID-19 . Brain diseases . Spinal cord diseases . ADEM . Child . Central Nervous System
Introduction The majority of COVID-19 pediatric patients are asymptomatic [1]. In the pediatric age group, very few reports of neurological manifestations are available [2, 3]. Multiple COVID-19–related neurological manifestations have been described in adults, such
as anosmia, ageusia, headache, encephalopathy, acute hemorrhagic necrotizing encephalopathy, meningitis, Guillain-Barre syndrome, stroke, myopathy, and acute disseminated encephalomyelitis (ADEM) [4–7]. Neurologic damage may occur by direct virus lesion, cytokine-related injury, and secondary hypoxia [7, 8]. We report a case of acute disseminated
* Adélia Maria de Miranda Henriques-Souza [email protected] Ana Cláudia Marques Gouveia de Melo [email protected] Bianca de Aguiar Coelho Silva Madeiro [email protected] Leonardo Furtado Freitas [email protected] Pedro Augusto Sampaio Rocha-Filho [email protected]
Fabrício Guimarães Gonçalves [email protected] 1
Hospital da Restauração, Recife, Brazil
2
Hospital Universitário Oswaldo Cruz, Universi
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