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• W3204105583 abstract "Introduction: COVID-19 has rampaged populations worldwide and in the United States (US) alone, has resulted in over 25,000,000 cases of infection with over 450,000 of those cases resulting in death. While the majority of reported cases are in the adult population, and most children infected with COVID-19 are asymptomatic or have benign upper respiratory tract infection, a subset of the pediatric population may develop multisystem inflammatory syndrome (MIS-C). MIS-C is becoming increasingly more reported and pediatric patients may present with symptoms at the time of the illness or more commonly 1-6 wks following an infection with COVID-19. Data suggests MIS-C is likely the result of an uncontrolled inflammatory response and cytokine storm following an infection with COVID-19, however, the mechanisms, disease process and risk factors still remain elusive. COVID-19 is known to cause a wide range of symptoms including gastrointestinal, hematologic, mucocutaneous, respiratory, musculoskeletal and less commonly, neurologic manifestations. While the annual incidence of pediatric arterial ischemic stroke cases range from 1.3 to 1.72 cases per 100,000 children, little is known about the occurrence rate of stroke following the COVID-19 infection and MIS-C. The following case series highlights a recent cluster of three cases of stroke following COVID-19 infections. Methods: Patient 1 was a 13-year-old Caucasian male with no past medical or family history but was reported to be completely unimmunized. He presented with a 5-day history of brain fog, amnesia, word-finding difficulty, slow verbal responses and expressive aphasia. Patient 2 was a 15-year-old Hispanic male with a past medial history of lupus, lupus nephritis, hypertension and chronic kidney disease. He presented initially at an outside hospital with chest pain, confusion and dizziness, work up was negative, so he was discharged home. Three days later he developed expressive aphasia, returned to the outside hospital and was transferred to our facility. Patient 3 was a 17-year-old Caucasian female with a past medical history of migraines for 5 years and Bipolar disorder. She presented first with confusion, and a severe headache but became progressively altered, experienced crying spells, constant movements and child-like behaviors. Results: Patient 1 had a positive COVID-19 PCR in December 2020, but tested negative at our facility on admission (about 1 month later) for COVID-19 PCR. He was, however, confirmed to be antibody positive for COVID-19. A brain magnetic resonance imaging (MRI) with and without contrast reported multiple areas of recent infarction with some enhancement bilaterally in the front lobes and inferior cerebellum, with no evidence of hemorrhagic transformation. A lumbar puncture (LP), complete metabolic panel (CMP), complete blood count (CBC), urine drug screening (UDS) and coagulation studies including protein C, protein S, factor V and antiphospholipid antibody, D-dimer, fibrinogen were assessed. Patient 1 was found to have an elevated D-dimer 1633 ng/mL, and slightly elevated liver function tests, ultimately, he was found to be positive for antiphospholipid antibody. Given the length of time since the onset of symptoms, patient 1 was started on aspirin 162 mg by mouth daily (antiplatelet dosing) and speech therapy was ordered for out-patient care. Patient 2 was reported to have a positive COVID-19 PCR in December 2020 and again tested positive over a month later at our facility. A MRI was performed and reported as left temporoparietal infarct with no hemorrhagic conversion. Further vascular studies ruled out venous stenosis, occlusion, aneurysm or vascular malformation. Laboratory test including a LP, CMP, CBC, coagulation studies and a urine drug screening were performed. His D-dimer was 1287 ng/mL, Creactive protein and liver function tests were slightly elevated, and UDS was positive for cannabinoids. Patient 2 was found to be positive for antiphospholipid antibody. Due to delayed care, thrombolytics were not used, but he was initiated on a pirin 324 mg by mouth daily (antiplatelet dosing) and enoxaparin 40 mg subcutaneously q 12 hrs with a reported anti-Xa of 0.3 IU/mL. Patient 3 was found to be COVID-19 PCR positive on admission, with a documented initial positive COVID-19 PCR two months prior at an outside facility. Multiple laboratory test were collected including a LP, CMP with liver function tests, CBC panel, and inflammatory markers. All laboratory tests were in normal limits with the exception of D-dimer which was elevated and reported as 2,249. Her urine drug screening was negative for toxins assessed. MRI with and without contrast was reported as multiple scattered bilateral supratentorial and right cerebellar hemisphere acute infarcts without hemorrhagic transformation. She was initiated on enoxaparin 1mg/kg/dose subcutaneously every 12 hours and we are awaiting further studies. Conclusion: While mortality in the pediatric population following COVID-19 infection is rarely reported, high rates of life-changing morbidities such ischemic strokes are beginning to surface. It is important to continue to define the pediatric population most at-risk for MIS-C and specifically those patients with predispositions for acute inflammation targeted to certain body systems, such as seen in the three reported pediatric cases." @default.
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• W3204105583 date "2021-01-01" @default.
• W3204105583 modified "2023-09-26" @default.
• W3204105583 title "COVID-19 is out of its mind: A case series of strokes in pediatric patients after COVID-19 infection" @default.
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