Severe Pediatric Neurological Manifestations with Multisystem Inflammatory Syndrome in Children (MIS-C) Linked to COVID-19 Pandemic: ARetrospective Cross-Sectional Study

Background: Since December 2019, COVID-19 has caused global health challenges. Among pediatric populations, SARS-CoV-2 infections have led to severe multisystem inflammatory syndrome in children (MIS-C), often accompanied by neurological complications. Objective: This study aimed to assess and characterize the neurological manifestations of MIS-C in pediatric patients with COVID-19. Methods: A retrospective cross-sectional cohort study was conducted on 303 pediatric patients admitted to a pediatric intensive care unit in Upper Egypt between March 2020 and March 2023. Patients were divided into three groups: Group I (MIS-C, PCR-positive), Group II (MIS-C, serologypositive), and Group III (non-MIS-C, PCR-positive). Neurological symptoms, laboratory markers, and outcomes were analyzed. Results: Neurological manifestations were most frequent in Group II (53.5%), followed by Group I (45.0%) and Group III (14.3%). Convulsions, decreased consciousness, headaches, and weakness were significantly more common in Group I. Inflammatory markers (CRP, D-dimer, ferritin, and troponin) were elevated in Groups I and II. Radiological abnormalities were infrequent, and neuroimaging findings showed no significant intergroup differences. Hospital stays were longest for Group I (mean 7.8 days), and mortality was highest in Group I (21.7%). Severe neurological symptoms correlated with adverse outcomes. Conclusion: This study emphasizes the high prevalence of neurological symptoms in pediatric patients with COVID-19-associated MIS-C, especially in those with positive serology. Symptoms like convulsions, decreased consciousness, headaches, and weakness were more common, with severe cases linked to elevated ferritin and D-dimer levels and abnormal neuroimaging findings. It highlights the importance of thorough neurological assessments in these patients and calls for further research into the long-term neurological effects of COVID-19 in children.