Table 1.
Cases of cerebral vasculitis after SARS-CoV-2 infection in patients under the age of 18 years.
| Patient | Age at onset | Sex | Period from infection to vasculitis | Symptoms associated with vasculitis | SARS-CoV-2 |
Laboratory data | CSF examination | Imaging or histological findings suggesting cerebral vasculitis | Comorbidities or complications | Treatment | Prognosis | Reports [ref.] | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (years) | PCR | Antibody | |||||||||||
| 1 | 1 | Female | 2 months | Irritability, unable to walk, left hemiparesis | negative | positive (serum) | normal | n.d. | Brain MRI: subacute infarct in the right MCA territory; severe focal stenosis in the M1 segment of the right MCA. | None | mPSL, Nimodipine, ASA | Improved | Avital D.7 |
| 2 | 8 | Female | 2 weeks | Left hemiparesis | positive (NP), negative (brain) | positive (serum, CSF) | CRP 0.8 mg/dL, ESR 11 mm/h | Cells 3/µL, protein 21 mg/dL, glucose 72 mg/dL; negative PCR panel including HSV and VZV | Brain MRI: a right frontal lobe enhancing lesion with vasogenic edema, histology: vasculitis (infarct-like necrosis with perivascular lymphohistiocytic inflammatory infiltrates) | Secondary macrophage activation syndrome | mPSL, IVIG, plasmapheresis, CYC, RTX | Deceased | Poisson KE.8 |
| 3 | 8 | Female | 3 weeks | Right hemiplegia, language impairment | negative | positive | CRP 2.7 mg/mL, IL-6 3.2 pg/mL | n.d. | Brain MRI: proximal left M1 occlusion; thick concentric mural enhancement of left ICA | Iron deficiency anemia (blood transfusion) | mPSL, ASA | Walk with support | Appavu B.9 |
| 4 | 12 | Male | n.d. | Generalized seizures, right hemiparesis, and dysarthria | positive (NP, CSF) | n.d. | CRP 0.3 mg/dL, ESR 45 mm/h | No white blood cells, protein 21 mg/dL, glucose 62 mg/dL; negative PCR for HSV and VZV | Brain MRI: acute infarction, along with focal irregular narrowing and banding of the proximal M1 segment of the left MCA. | None | Diazepam | Right hemiparesis | Mirzaee SMM.10 |
| 5 | 13 | Female | 2 months | Persistent headache, speech difficulty, right hemiparesis | positive (NP) | positive (serum) | normal | normal; negative PCR for multiple viruses including HSV and VZV | Brain MRI: acute-subacute infarcts in the left MCA vascular territory; focal moderate stenosis within the M1 segment of the left MCA; wall thickening and marked, concentric enhancement | None | n.d. | Improved | Gulko E.11 |
| 6 | 16 | Male | 8 days (17 days) | Fever, neck stiffness, stupor (right hemiplegia, aphasia) | positive (NP), negative (CSF) | n.d. | CRP 25 mg/dL, IL-6 15.6 pg/mL | Cells 1566/µL (76% neutrophils), protein 500 mg/dL, glucose 27 mg/dL | Brain MRI: vessel wall enhancement and stenosis of the left ICA, MCA, and anterior cerebral artery; arterial ischemic stroke in the left MCA territory and left ophthalmic vein thrombosis. | Bacterial meningitis, Lemierre syndrome | antibiotics, CS, TCZ, ASA | Deceased | de Marcellus C.12 |
| 7 | 16 | Male | 30 days | Lethargy, decreased responsiveness, right hemiparesis, global aphasia | positive (NP, infection), negative (NP, vasculitis) | n.d. | CRP 13.6 mg/mL, ESR 59 mm/h, positive lupus anticoagulant | n.d. | Brain MRI: complete left MCA territory infarction, irregularity of left M1, and occlusion of left MCA bifurcation; no mural enhancement | Multiple organ system dysfunctions | Heparin, Enoxaparin | Dysarthria, aphasia, right hemiparesis | Appavu B.9 |
| 8 | 16 | Male | n.d. | Cardiopulmonary arrest | positive (NP) | n.d. | n.d. | n.d. | Histology: vasculitis in medium-sized vessels | Idiopathic cardiomegaly, thrombotic microangiopathy in the lung | n.p. | Deceased | Daisley Jr H.13 |
| Present case | 9 | Male | no infection | Left-sided headache, irritability, fever | negative (NP) | n.p. | CRP 0.06 mg/dL, ESR 52 mm/h | Cells 212/µL, protein 69 mg/dL, glucose 38 mg/dL; negative PCR for SARS-CoV-2, HSV, and VZV | Brain MRI: cortical high-intensity areas in the left cerebral hemispheres; stenosis in the left ICA and MCA; vessel wall thickening and enhancement | None | IVMP, PSL, ASA | No neurological sequelae | |
SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; NP, nasopharyngeal; CSF, cerebrospinal fluid; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; n.d., not described; n.p., not performed; CS, corticosteroid; TCZ, tocilizumab; ASA, acetylsalicylic acid; CYC, cyclophosphamide; RTX, rituximab; IVIG, intravenous immunoglobulin; IFNX, infliximab; HQ, hydroxychloroquine; IVMP, intravenous methylprednisolone; mPSL: methylprednisolone; PSL, prednisolone; MCA, middle cerebral artery; ICA, internal caroid artery; HSV, herpes simplex virus; VZV, varicella zoster virus; PCR, polymerase chain reaction; IL, interleukin.