Neurovisual Manifestations in Children with Mild COVID-19: An Association to Remember

ABSTRACT

Neurovisual involvement has been reported in a number of patients with severe SARS-CoV-2 disease (COVID-19), mainly among adult patients. In children, such involvement has been reported in rare cases, often in those presenting with severe forms of COVID-19. The aim of this work is to explore the association between mild COVID-19 and neurovisual manifestations. We report the cases of three previously healthy children who developed neurovisual manifestations following mild acute COVID-19, analysing the clinical phenotype, the latency between the onset of acute COVID-19 and neurovisual involvement, and the kinetic of resolution. Our patients developed different clinical patterns, including visual impairment and ophthalmoplegia. In two cases, these clinical features occurred during acute COVID-19, while in the third patient their development was delayed after 10 days from disease onset. Furthermore, the dynamics of resolution were different, with one patient showing remission after 24 hours, the second after 30 days, and the third showing persistence of the strabismus after 2 months of follow-up. The spreading of COVID-19 among the paediatric population will probably lead to an increase of atypical disease forms, including those presenting with neurovisual involvement. Therefore, a better knowledge of the pathogenic and clinical features of these manifestations is warranted.

KEYWORDS:

• Neurovisual manifestations
• COVID-19
• paediatric ophthalmology
• opthalmoplegia
• neuro-COVID19

Author contribution

AO, AB, AS, FO, and RB conceptualised this work. GC, MV, AS, MED, and TF drafted the initial paper, which was critically revised by AO, RB, MCR, RC, and DP. All the authors approved the final version of this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work has been partially supported by grant from the IRCCS Stella Maris Foundation (Ricerca Corrente, and the 5 × 1000 voluntary) contributions, Italian Ministry of Health. (RB, TF).