Clinical investigation of children with acute encephalopathy associated with COVID-19 infection

Abstract

As a result of the outbreak caused by the Omicron SARS-CoV-2 variant of coronavirus disease 2019 (COVID-19) in Japan,the number of pediatric patients has increased,and neurological complications have been reported. In this report,we describe two cases of COVID-19-related acute encephalopathy.

(Case presentation) Case 1: A 4-year-old boy with delayed motor development. He was diagnosed as acute encephalopathy with biphasic seizures and late reduced diffusion. The patient was treated with intravenous methylprednisolone (IVMP) and thyrotropin-releasing hormone (TRH). The patient was left with severe mental retardation and higher functional disability. Case 2: A 5-year-old girl with a history of febrile seizures. She presented with convulsive seizures and prolonged disturbance of consciousness. Cerebrospinal fluid (CSF) interleukin-6 was elevated at 364 pg/mL. She was diagnosed as febrile seizure and was treated with remdesivir,but her consciousness became prolonged and diffusion-weighted brain magnetic resonance imaging (MRI) showed hyperintensity in the left frontal lobe. The patient was diagnosed as unclassifiable acute encephalopathy. IVMP was administered with no apparent neurological sequelae. Based on cytokine analysis,we hypothesized that immunological mechanisms,such as hypercytokinemia,increased permeability of the blood-brain barrier,and vascular endothelial damage may cause COVID-19-related central nervous system complications.