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 European Journal of Paediatric Neurology 39 (2022) 116–117

Contents lists available at ScienceDirect

European Journal of Paediatric Neurology

journal homepage: www.journals.elsevier.com/european-journal-of-paediatric-neurology

Letter to the Editor

Neuro-COVID is not at variance between children and adults

A R T I C L E I N F O

Keywords
SARS-CoV-2
COVID-19
Nervous system
Adults
Pediatric

Letter to the Editor in this particular patient and if ANA, ANCA, or blood sedimentation rate
were elevated.
We read with interest the article by Gürlevik et al. about a case series
Five patients were diagnosed with encephalopathy [1]. We should be
of 15 paediatric patients with neuro-COVID [1]. It was concluded that
told upon which diagnostic criteria encephalopathy was diagnosed.
children with COVID-19 can present with neurologic abnormalities such
Patient-12 was diagnosed with critical ill neuropathy [1]. Upon
as encephalopathy, seizures, cerebrovascular events as well as abnormal
which diagnostic criteria was critical ill neuropathy diagnosed? Ac­
eye movements [1]. The study is appealing but raises concerns that
cording to table 1 patient-12 had not been admitted to the ICU. How did
require discussion.
this patient acquire critical ill neuropathy?
Only a small spectrum of neuro-COVID had been diagnosed in the
Patient-13 was diagnosed with neuropathic pain [1]. We should
included patients. However, the spectrum of neurological disease trig­
know which type of neuropathy was diagnosed in this particular patient.
gered by SARS-CoV-2 is much broader, even in children and additionally
It is not comprehensible why patients with headache, loss of taste
includes venous sinus thrombosis, PRES, immune encephalitis, multiple
and loss of smell were excluded from the study. These symptoms are
sclerosis, cerebral bleeding, and others [2,3]. The reason for the
typical neurological manifestations of neuro-COVID and should be
discrepancy between the narrow spectrum of neuro-COVID in the study
included in the investigation.
population and the literature should be discussed.
Overall, the interesting study has some limitations and in­
Patient 14 and 15 were diagnosed with SARS-CoV-2 associated
consistencies which challenge the results and their interpretation.
myositis [1], but neither a muscle MRI with contrast medium nor a
Addressing these limitations may upvalue the conclusions. Neuro-
muscle biopsy had been carried out. Diagnosing myositis solely upon the
COVID of the central or peripheral nervous system is not at variance
clinical presentation can be misleading. We should be told how myositis
between children and adults why similarities prevail over discrepancies.
was diagnosed in these two patients.
Patient-2 was described with ocular dysmotility [1]. However, a
cerebral MRI with contrast medium to rule out brainstem encephalitis or Funding
another causative lesion had not been carried out [1]. The cerebral CT,
which has been described as normal may miss brainstem encephalitis. No funding was received.
Patient-5 had been diagnosed with hydrocephalus [1]. We should be
informed about the cause and pathophysiological background of hy­ Author contribution
drocephalus. Additionally, we should be told which treatment this
particular patient received and if hydrocephalus resolved upon appli­ JF: design, literature search, discussion, first draft, critical com­
cation of the treatment. ments, DM: literature search, discussion, critical comments, final
How was intracranial hypertension diagnosed in patient-8? Upon a approval.
spinal tap or by means of an intracranial pressure probe?
Patient-9 was diagnosed with cerebral vasculitis [1]. However, Informed consent
neither a cerebral computed tomography angiography (CTA) nor a bi­
opsy of a cerebral artery had been carried out to confirm the diagnosis. Not applicable.
We should be told upon which criteria cerebral vasculitis was diagnosed The study was approved by the institutional review board.

Abbreviations: ANA, Antinuclear antibodies; ANCA, Antineutrophil cytoplasmic antibodies; CTA, Computed tomography angiography; ICU, Intensive care unit;
PRES, Posterior reversible encephalopathy syndrome.

https://doi.org/10.1016/j.ejpn.2022.06.005
Received 24 March 2022; Accepted 7 June 2022
Available online 15 June 2022
1090-3798/© 2022 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
Letter to the Editor European Journal of Paediatric Neurology 39 (2022) 116–117

Declaration of competing interest meta-analysis, J. Trop. Pediatr. 67 (2021), https://doi.org/10.1093/tropej/fmaa070

fmaa070.

The authors declare no conflicts of interest.

Josef Finsterer*
References Neurology Neurophysiology Center, Vienna, Austria
Daniel Matovu
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*
A.E. Gogu, A. Docu Axelerad, Neurological manifestations found in children with Corresponding author. Postfach 20, 1180, Vienna, Austria.
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