Multisystem Inflammatory Syndrome (MIS-C) Clinical Pathway — Emergency, ICU and Inpatient

Neurologic Signs/Symptoms of COVID-19/MIS-C

The following neurologic complications have been reported in adults with COVID - it is not yet clear if findings are the same for children.

  • Acute encephalopathy (altered mental status, lethargy/drowsiness, or agitation)
  • Headache
  • Dizziness or lightheadedness
  • Ataxia, balance, or coordination problems
  • Altered sense of smell (anosmia)
  • Altered sense of taste (dysgeusia)
  • Stroke
  • Guillain-Barre syndrome
  • Seizure
  • Sympathetic storming
  • Meningitis/encephalitis
  • Other focal neurologic deficits:
    • Visual impairment
    • Weakness or numbness

The following neurologic findings have been reported in children with MIS-C:

  • Altered mental status (irritability, lethargy)
  • Nuchal rigidity
  • Aseptic meningitis
  • Cerebral edema
  • Papilledema
  • Cranial nerve palsies
  • Intracranial hypertension

Some symptoms (e.g. headache, dizziness) may be related to direct neurologic involvement of SARS-CoV-2 or to systemic illness

Recommended Neurologic Assessment

  • History (over the last 3 weeks) of:
    • Headache
    • Neck stiffness
    • Altered mental status (e.g. lethargy, irritability, agitation, hallucinations)
    • Vision impairment (e.g. blurry or double vision)
    • Smell and/or taste impairment (anosmia/dysgeusia)
    • Balance/coordination problems
    • Syncope (e.g. lightheadedness)
  • Physical exam:
    • Mental status including GCS
    • Cranial nerves
      • Pupils
      • Extraocular movements (esp horizontal)
      • Cough/gag
      • Bulbar function (e.g. handling secretions)
  • Strength of all 4 extremities
  • Nuchal rigidity (or other meningismus- Kernig, Brudzinski)
  • Finger-nose-finger, gait (looking for ataxia)

Neurology consult, brain imaging, EEG monitoring and CSF studies should be considered per usual clinical standards including exclusion of alternative diagnoses.