Global collaboration studies largest ever group of children with brain or spinal complications related to COVID-19

In the summer of 2020, an international research collaboration was established, including Neuroradiologists from Great Ormond Street Hospital (GOSH), to better understand the symptoms of COVID-19 in children.Set up with the support of the American Society of Paediatric Neuroradiology and with expertise and experience from France, UK, USA, Brazil, Argentina, India, Peru, and Saudi Arabia, the team was able to compare global trends and behaviours of COVID-19 in children.

By connecting a worldwide network of doctors, they studied records from eight countries and 111 coronavirus-related cases were submitted to their call. After initial review of 80 suitable cases, 38 children could be included in the study.

The children had symptoms including fever, reduced consciousness, problems moving their arms and legs and cognitive dysfunction, but eight of these children did not have the usual coronavirus symptoms. Early diagnosis is important in the rare cases of severe COVID-19 infection in children, but testing had not always been routinely carried out when a child had neurological symptoms.

The research team compared the MRI scans taken when the child had their symptoms and recognised similar patterns in the brain and spinal cord, indicating that scans could prove a useful diagnostic tool in cases where the cause of a child’s illness was difficult to determine, particularly in emergency settings.

The study was largely undertaken on a voluntary basis by the international cohort, allowing them to remotely study the largest ever group of children with brain or spinal complications related to COVID-19.

Dr Kish Mankad, one of the primary authors on the study and Consultant Paediatric Neuroradiologist at GOSH said:

“It is important to remember that neurological complications are rare in children with COVID-19, and the majority of children who develop neurological signs recover uneventfully.’’

“Our study shows that a relatively simple MRI scan of the head and spine at presentation can show abnormalities that could indicate a COVID-19 infection, even if the child doesn’t have the classic symptoms of the virus, like breathlessness or a cough. This could be important in an emergency setting where doctors might struggle to explain why a child is having difficulty walking or talking.”

“We have long known that different viruses can impact on the brain and spine, but until this study, we couldn’t really say for sure that COVID-19, though rare, could also have this effect.”

Dr Owen Arthurs, Consultant Paediatric Radiologist and Radiology Lead for Research and Innovation said:

"As with all rare diseases, it's critical that we contribute our cases to multi-centre research such as this. As a leading children's hospital who have seen several sick children with COVID-19, it's great that we can share our imaging and clinical experience in this way."

The researchers could not determine how common such neurological complications are in children with COVID-19, or exactly how common the MRI pattern is for children with those complications, as they focussed on cases where the imaging was abnormal. In a small number of these children, the neurological affects were serious, but the majority recovered well. Most of the children studied (32/38) have now recovered or are recovering, but four have sadly died from coinfections such as tuberculosis after COVID-19 potentially made them more susceptible to other infections. Two children now have paralysis after the virus affected their spinal cord.

Of the 38 children with neurological disease related to SARS-CoV-2 infection 13 came from France, 8 from the UK, 5 from the USA, 4 from Brazil, 4 from Argentina, 2 from India, 1 from Peru, and 1 from Saudi Arabia.

Notes to Editors

The paper ‘Neuroimaging manifestations in children with SARS-CoV-2 infection: a multinational, multicentre collaborative study’ was published in Lancet Child and Adolescent Health.

All research at GOSH and UCL Great Ormond Street Institute of Child Health is supported by the NIHR GOSH Biomedical Research Centre.