Schupper AJ, Yaeger KA, Morgenstern PF. Neurological manifestations of pediatric multi-system inflammatory syndrome potentially associated with COVID-19. Childs Nerv Syst. 2020;36(8):1579-1580. doi:10.1007/s00381-020-04755-8
There has been significant media attention and a New York City Health Alert  surrounding “Pediatric Multi-System Inflammatory Syndrome Potentially Associated with COVID-19.” As of May 18, 2020, there were 145 suspected cases of this syndrome in New York City . While this disease has been outlined as having components shock and similarities to Kawasaki disease, associated neurologic manifestations have not been described (https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pd). We have encountered several children with this condition and highlight two with major neurological complications.
A 5-year-old boy with no significant past medical history presented with several days of fever, cough, and abdominal pain. He progressed to cardiogenic shock and transfer to our institution, where he tested positive for COVID-19 antibodies and had high IL-6 levels. He developed cardiopulmonary failure requiring extracorporeal membrane oxygenation (ECMO). After 5 days of ECMO, he was found to have a fixed and dilated right pupil. His heparin was emergently reversed, he was decannulated, and emergent CT head revealed a right middle cerebral artery (MCA) infarction, cerebral edema, and diffuse contralateral subarachnoid hemorrhage (Fig. 1a). Following the CT scan, his left pupil became fixed and dilated. The reversal of his paralytic revealed absent brainstem reflexes and movement. Brain death was confirmed 3 days later following normalization of his electrolytes.
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