Is a Brain Stroke Caused by COVID-19 Seen Under Two Years of Age? A Case Report

Mohammad Vafaee Shahi; Sedigheh Yousefzadegan; Ramin Zare Mahmoudabadi; Fatemeh Ahmadi; Aina Riahi

doi:10.4274/tnd.2021.42492

Mohammad Vafaee Shahi¹, Sedigheh Yousefzadegan², Ramin Zare Mahmoudabadi³, Fatemeh Ahmadi⁴, Aina Riahi⁵

¹Pediatric Growth and Development Research Center, Iran University of Medical Sciences, Tehran, Iran
²Firouzabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
³Department of Pediatrics, Firouzabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences, Tehran, Iran
⁴Rasool Akram Hospital, Iran University of Medical Science, Tehran, Iran
⁵Minimally Invasive Surgery Research Center, Iran University of Medical Science, Tehran Iran

Keywords: COVID-19, SARS CoV-2, infant, children, stroke, MIS-C

Abstract

Brain ischemic stroke in children, especially in infancy, is a rare condition. Stroke presents a variety of symptoms and usually is an underestimated diagnosis in infants. The current coronavirus disease-2019 (COVID-19) pandemic involves different organs in the human body, such as the central nervous system. Researchers believe a probable association between this RNA virus and stroke but with a few cases of strokes in the pediatrics field with positive reverse transcriptionpolymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2). Herein, reported a 17-month-old girl with hemiparesis and focal status epilepticus that was admitted to Firoozabadi Hospital. The onset of symptoms was approximately 4 days before the admission with a non-bloody and watery diarrhea, nausea, vomiting, and a low-grade fever. The brain magnetic resonance imaging with diffusion-weighted imaging sequence confirmed acute ischemic stroke (AIS). COVID-19 RT-PCR test was requested due to the multisystemic involvement, which revealed a positive result. Thus, according to the positive RT-PCR and other negative results along with fever and gastrointestinal involvement, which is a common form of COVID-19 infection in pediatric patients, her neurological symptoms were confirmed with COVID-19 infection. Based on our knowledge, this is the first case of AIS due to SARS CoV-2 infection that was reported under 2 years of age worldwide. COVID-19 infection in pediatric patients has different presentations. In a significant number of these patients, the involvement of more than two body organs could be seen, known as “multisystem inflammatory syndrome in children” that is associated with COVID-19. Some strokes due to COVID-19 infection were reported with its association to hypercoagulability state, thus we introduce a related case of one infant. According to the new emerging coronavirus and its probability of nervous system involvement, checking the COVID-19 RT-PCR test in the nasopharynx and cerebrospinal fluid of all children who present with neurological symptoms is recommended, even in the post-COVID-19 era.