Puppo CCJ, Cardoso EHR, Suárez HS, Velázquez DPX

Language: Spanish
References: 13
Page: 183-186
PDF size: 224.95 Kb.

ABSTRACT

A 11-year-old female with headache, generalized abdominal pain and fever of 38.5 ^oC; SARS-CoV-2 RT-PCR (+) detection test was performed. After a few days, he went to the emergency room with headache, abdominal pain, paresthesias in the hands that progressed to the upper and lower limbs, muscle weakness, dysphagia and retrosternal pain. On physical examination, muscle stretch reflexes (MSR) in proximal and distal upper limbs ++/++++, MSR in lower limbs +/++++ proximal and 0/++++ distal. Muscle strength (Daniels scale) in proximal and distal lower limbs 4; muscle strength of upper limbs 4 proximal and 3 distal. The electroneuromyographic study is reported with severe axonal motor neuropathy in four extremities. The MRI of the skull and spine applied abnormal enhancement of the roots of the equine tail and medullary cone, compatible with acute demelizing polyradiculopathy. Miller-Fisher syndrome (MFS) secondary to SARS-CoV-2 infection is reported in seven cases in adults and few reports in children around the world. Serious neurological complications in this age group are less than 1% of cases and mainly observed in severe COVID-19.

REFERENCES

1. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19)-China, 2020. China CDC Weekly. 2020; 2 (8): 113-122.

2. Parcha V, Booker KS, Kalra R, Kuranz S, Berra L, Arora G et al. A retrospective cohort study of 12,306 pediatric COVID-19 patients in the United States. Sci Rep. 2021; 11 (1): 10231. doi: 10.1038/s41598-021-89553-1.

3. Panda PK, Sharawat IK, Panda P, Natarajan V, Bhakat R, Dawman L. Neurological complications of SARS-CoV-2 infection in children: a systematic review and meta-analysis. J Trop Pediatr. 2021; 67 (3): fmaa070. doi: 10.1093/tropej/fmaa070.

4. Abdel-Mannan O, Eyre M, Lobel U, Bamford A, Eltze C, Hameed B et al. Neurologic and radiographic findings associated with COVID-19 infection in children. JAMA Neurol. 2020; 77 (11): 1440-1445. doi: 10.1001/jamaneurol.2020.2687. Erratum in: JAMA Neurol. 2020; 77 (12): 1582.

5. Mane SS, Nagesh U, Sathe VT, Janadhanan J. Miller Fisher variant of Guillain-Barré syndrome in a child. J Pediatr Neurosci. 2020; 15 (1): 60-62. doi: 10.4103/JPN.JPN_146_18.

6. Jang Y, Choi JH, Chae JH, Lim BC, Kim SJ, Jung JH. Pediatric Miller Fisher syndrome; characteristic presentation and comparison with adult Miller Fisher syndrome. J Clin Med. 2020; 9 (12): 3930. doi: 10.3390/jcm9123930.

7. Li Z, Li X, Shen J, Chan MTV, Wu WKK. Miller Fisher syndrome associated with COVID-19: an up-to-date systematic review. Environ Sci Pollut Res Int. 2021; 28 (17): 20939-20944. doi: 10.1007/s11356-021-13233-w.

8. Christy A. COVID-19: a review for the pediatric neurologist. J Child Neurol. 2020; 35 (13): 934-939. doi: 10.1177/0883073820939387.

9. Ajena D, Ferrari S, Romito S, Zaglia F, Biban P, Squintani G. A pediatric case of Miller Fisher syndrome with central involvement. Neurol Sci. 2013; 34 (9): 1689-1690. doi: 10.1007/s10072-012-1255-y.

10. Paparounas K. Anti-GQ1b ganglioside antibody in peripheral nervous system disorders: pathophysiologic role and clinical relevance. Arch Neurol. 2004; 61 (7): 1013-1016. doi: 10.1001/archneur.61.7.1013.

11. Principi N, Bosis S, Esposito S. Effects of coronavirus infections in children. Emerg Infect Dis. 2010; 16 (2): 183-188. doi: 10.3201/eid1602.090469.

12. Yeh EA, Collins A, Cohen ME, Duffner PK, Faden H. Detection of coronavirus in the central nervous system of a child with acute disseminated encephalomyelitis. Pediatrics. 2004; 113 (1 Pt 1): e73-e76. doi: 10.1542/peds.113.1.e73.

13. Montalvan V, Lee J, Bueso T, De Toledo J, Rivas K. Neurological manifestations of COVID-19 and other coronavirus infections: a systematic review. Clin Neurol Neurosurg. 2020; 194: 105921. doi: 10.1016/j.clineuro.2020.105921.