Session Title: AA 2021 Virtual Posters - Pediatric Rehabilitation
Session Time: None. Available on demand.
Disclosures: Rosalie Ellis: No financial relationships or conflicts of interest
Case Diagnosis: Post-infectious vasculopathic stroke.
Case Description: A 13-month-old previously healthy female presented with right-hemiparesis a week after developing rhinorrhea. This was an acute (hours) decline in function from baseline. Physical exam showed NIHSS 5 with right facial asymmetry, drooling, proximal RUE>RLE weakness, and right-sided neglect.
Setting: Inpatient pediatric rehabilitationAssessment/
Results: Lab workup was unremarkable, except for prior COVID-19 antibody positivity without active illness. MRI demonstrated a left basal ganglia (putamen) stroke. Angiogram confirmed irregularity and beading of the lenticulostriate arteries from the left MCA-M1 segment, consistent with post-infectious ischemic vasculopathy. Work-up was negative, including Doppler, echo, coag/thrombophilic profile and genetics. Along her inpatient rehabilitation treatment, the patient made significant functional gains with restoration of neurological function back to baseline.
Discussion: Children make up 2-11% of COVID-19 cases. Of symptomatic children with COVID-19, a rare but serious complication is multi-system inflammatory syndrome (MIS), in which 15-47% of patients develop neurological symptoms ranging from headache, altered mental status, seizure, and stroke (about 6% of cases). Studies have suggested that strokes in COVID-19 patients have been attributed to increased inflammatory markers triggered by SARS-Cov-2 binding to ACE-2 receptors, leading to a cytokine storm that causes thrombosis and vasculitis. To date, there is minimal research published regarding strokes on post-COVID-19 pediatric patients. Our literature review showed only 2 similar case reports to ours, both of proximal ischemic changes of the M1 segment with focal cerebral arteriopathy of MIS.
Conclusion: Only a few case reports have been published regarding post-infectious (COVID-19) vasculopathic stroke in children, and only 6% of neurological complications are stroke-related. Here, we highlight this important complication, and raise awareness to this potential association in the pediatric population.
Level of Evidence: Level V
To cite this abstract in AMA style:Ellis R, Hartman K, Barndt B, Francio V. Pediatric Post-infectious Ischemic Vasculopathic Stroke: A Potential Neurological Complication Associated with COVID-19 Infection [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/pediatric-post-infectious-ischemic-vasculopathic-stroke-a-potential-neurological-complication-associated-with-covid-19-infection/. Accessed December 3, 2023.
« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/pediatric-post-infectious-ischemic-vasculopathic-stroke-a-potential-neurological-complication-associated-with-covid-19-infection/