Neuroimaging spectrum of immune-mediated central nervous system disorders in children following SARS-CoV-2 infection: A case series

Abstract

Objective

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with neurological complications beyond respiratory involvement. Although children usually experience mild systemic disease, immune-mediated central nervous system (CNS) disorders have emerged as an important cause of morbidity. Neuroimaging plays a central role in detecting these complications and supporting diagnostic decisions. This study aims to describe neuroimaging patterns in children who developed immune-mediated CNS disorders following SARS-CoV-2 infection.

Materials and methods

We retrospectively reviewed pediatric patients aged 0–18 years with laboratory-confirmed SARS-CoV-2 infection followed at a tertiary pediatric neurology center. Among post-COVID admissions, four patients with severe neurological involvement and characteristic neuroimaging abnormalities were identified. Clinical features, laboratory findings, cerebrospinal fluid analyses, electroencephalography results, and multimodal neuroimaging studies were evaluated.

Results

Four previously healthy male children developed immune-mediated neurological disorders associated with SARS-CoV-2 infection, including febrile infection–related epilepsy syndrome, acute disseminated encephalomyelitis, central nervous system vasculitis, and anti–N-methyl-D-aspartate receptor encephalitis. Brain MRI demonstrated disorder-specific patterns such as cortical diffusion restriction, multifocal demyelinating lesions, inflammatory vasculitic changes, and progressive parenchymal injury. In one patient, serial imaging showed progression from acute inflammation to chronic structural damage. All patients received immunomodulatory therapy, with variable neurological outcomes.

Conclusion

SARS-CoV-2 infection may trigger immune-mediated CNS disorders in children with distinct neuroimaging features. Recognition of these patterns is essential for early diagnosis, treatment guidance, and prognostic assessment. Neuroimaging also provides insight into the evolution of post–COVID-19 neuroinflammatory injury.