ABSTRACT
Background: Neurological manifestations have been reported both in adults and children with coronavirus disease 2019 (COVID-19). Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a recently described severe post-infectious immune-mediated disorder. Objective: Our aim was to report neurological manifestations of children with PIMS-TS. Methods: Patients (<18y) presenting to Great Ormond Street Hospital between April 4, 2020, and May 1, 2021 fulfilling PIMS-TS criteria, were included. Clinical and paraclinical features were retrieved retrospectively from electronic patient records. Results: Data was available for 125 patients who presented during the study period. Median age was 10 years (IQR 7, 12), 71 (56.8%) were male and 96 (76.8%) were of non-white ethnicities. New-onset neurological symptoms were reported in 73/125 (58.4%);headaches (n=47), encephalopathy (n=41), hallucinations (n=15), ataxia (n=12), dysarthria/dysphonia (n=12), peripheral nerve involvement (n=3), and seizures (n=1). Thirteen patients had CSF examined;one patient had 118 leukocytes in CSF. Abnormalities were noted in 16/32 patients with neuroimaging, with splenium of the corpus callosum signal changes most commonly seen in 9 patients. An excess of slow activity was found in 78/98 who had an EEG;38 mild, 34 moderate and 7 had severe encephalopathy on EEG. Myopathic and neuropathic changes were seen in 7/12 who underwent nerve conduction studies and electromyography (EMG). Children with neurological involvement had higher peak inflammatory markers and were more likely to be ventilated and require inotropic support in PICU (p<0.05). Conclusions: Children with PIMS-TS presented with new neurological symptoms involving both the central and peripheral nervous systems, in the absence of respiratory symptoms. Neurological symptoms were seen more frequently in more severe presentations.