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October 2022; 12 (5) Cases

Pediatric SARS-CoV-2–Related Diplopia and Mesencephalic Abnormalities

Sara Signa, Noemi Brolatti, Chiara Trincianti, View ORCID ProfileDomenico Tortora, Carolina Saffioti, Eddi Di Marco, Maura Acquila, Elisabetta Amadori, Chiara Fiorillo, Erica Ricci, View ORCID ProfilePasquale Striano, Elio Castagnola, Maria Stella Vari
First published August 31, 2022, DOI: https://doi.org/10.1212/CPJ.0000000000200076
Sara Signa
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Noemi Brolatti
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Chiara Trincianti
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Domenico Tortora
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Carolina Saffioti
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Eddi Di Marco
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Maura Acquila
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Elisabetta Amadori
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Chiara Fiorillo
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Erica Ricci
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Pasquale Striano
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Elio Castagnola
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Maria Stella Vari
UOC Malattie Infettive (S.S., C.S., E.R., E.C.), IRCCS Istituto Giannina Gaslini; COVID Hospital (S.S., E.R.), IRCCS Istituto Giannina Gaslini; UOC Neurologia Pediatrica e Malattie Muscolari (N.B., E.A., C.F., P.S., M.S.V.), IRCCS Istituto Giannina Gaslini; Dipartimento di Neuroscienze (C.T., C.F., P.S.), Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova; UOC Neuroradiologia (D.T.), IRCCS Istituto Giannina Gaslini; and UOC Laboratorio Analisi (E.D.M., M.A.), IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Citation
Pediatric SARS-CoV-2–Related Diplopia and Mesencephalic Abnormalities
Sara Signa, Noemi Brolatti, Chiara Trincianti, Domenico Tortora, Carolina Saffioti, Eddi Di Marco, Maura Acquila, Elisabetta Amadori, Chiara Fiorillo, Erica Ricci, Pasquale Striano, Elio Castagnola, Maria Stella Vari
Neurol Clin Pract Oct 2022, 12 (5) e124-e128; DOI: 10.1212/CPJ.0000000000200076

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Abstract

Objective This case report describes a patient with mesencephalic MRI signal abnormality and diplopia, possibly associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Methods We describe a boy with binocular diplopia and nystagmus. The pattern of serology positivity and negative direct research of SARS-CoV-2 RNA in our patient allowed us to consider novel coronavirus as the trigger of possible immune-mediated phenomena against the central nervous system.

Results During hospitalization, blood tests revealed a recent SARS-CoV-2 infection. MRI revealed hyperintensity of the mesencephalic tegmentum and periaqueductal region, consistent with an inflammatory lesion of the midbrain tegmentum. Viral and bacterial molecular screening on cerebrospinal fluid and isoelectrofocusing analysis, anti–myelin oligodendrocyte glycoprotein, anti–aquaporine-4, and anti–N-methyl-d-aspartate antibodies were negative. The patient was treated with steroids and immunoglobulin therapy with complete remission of neurologic symptoms.

Discussion This report expands the spectrum of pediatric COVID-19–associated neurologic symptoms and highlights a possible isolated neurologic COVID-19–related symptom.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • ↵* These authors contributed equally to this work as first authors.

  • Submitted and externally peer reviewed. The handling editor was Editor Luca Bartolini, MD.

  • COVID-19 Resources: NPub.org/COVID19

  • Received April 14, 2022.
  • Accepted July 28, 2022.
  • © 2022 American Academy of Neurology
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