Objective

To characterize neurological involvement in multisystem inflammatory syndrome in children (MIS-C) related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Methods

Retrospective analysis of the clinical, electroencephalographic, CSF and neuroradiological parameters recorded in seven children (3 males, aged 3–10 years) affected by MIS-C with acute neurological involvement.

Results

All cases presented acute encephalopathy with drowsiness, irritability, mood deflection and diffuse EEG slowing with periodic posterior complexes. Focal neurological signs, normal brain MRI and CSF, were present in four patients; these patients received intravenous methylprednisolone at 30 mg/kg/day for 3 days. In all cases, the clinical picture rapidly improved in the first three days, and all neurological symptoms and EEG abnormalities disappeared within 10 and 30 days respectively. The severity and duration of the EEG abnormalities was proportional to the extent of the neurological involvement.

Conclusions

Patients with MIS-C may present acute encephalitis characterized by rapid-onset encephalopathy and EEG abnormalities (slow wave activity and/or epileptic abnormalities), in some cases associated with focal neurological signs that disappear with immunomodulatory therapy. The detection through neurological evaluation of sentinel neurological signs and distinctive EEG patterns documentable at disease onset will allow timely diagnosis and treatment of these cases.

中文翻译：

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与 COVID-19 相关的小儿多系统炎症综合征中的急性脑炎

客观的

旨在描述与严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染相关的儿童多系统炎症综合征 (MIS-C) 的神经系统受累情况。

方法

对 7 名受 MIS-C 影响并伴有急性神经系统受累的儿童（3 名男性，3-10 岁）记录的临床、脑电图、脑脊液和神经放射学参数进行回顾性分析。

结果

所有病例均出现急性脑病，伴有嗜睡、易怒、情绪偏转和弥漫性脑电图减慢并伴有周期性后部复合体。4 名患者出现局灶性神经系统体征、正常的脑 MRI 和 CSF；这些患者接受了 30 mg/kg/天的静脉注射甲基强的松龙 3 天。在所有病例中，前三天临床表现迅速改善，所有神经系统症状和脑电图异常分别在10和30天内消失。脑电图异常的严重程度和持续时间与神经系统受累的程度成正比。

结论

MIS-C 患者可能出现急性脑炎，其特征是快速发作的脑病和脑电图异常（慢波活动和/或癫痫异常），在某些情况下，与免疫调节治疗后消失的局灶性神经系统体征有关。通过对疾病发作时可记录的前哨神经体征和独特脑电图模式的神经学评估进行检测，将允许及时诊断和治疗这些病例。