Ischemic stroke associated with Multisystemic Inflammatory Syndrome in children after SARS-CoV-2 infection: a case report

Background: Multisystemic Inflammatory Syndrome in children (MIS-C) is a rare pediatric complication of coronavirus disease 2019 (COVID-19) which results in inflammation of various organ systems. Neurological involvement is a very rare compromised in children and only few cases of the ischemic cerebrovascular disease have been reported. Our objective is to analyze ischemic cerebrovascular disease in the context of multisystem inflammatory syndrome through a review of therapeutic approaches. Because acute ischemic stroke is uncommon in pediatric patients an opportune diagnose and treatment can reduce the morbidity and mortality. So, it is critical that clinicians are aware of the risk of stroke in the context of MIS-C. Case Description: A 5-year-old boy was admitted to the pediatric emergency room with a history of cough and fever. A private physician requested a serologic test for COVID-19 reporting reactive immunoglobulin G (IgG). He presented to the emergency room (ER) with bilateral eyelid edema, diffuse erythematous spots, cracked lips, and joint pain. Physical examination showed dry oral mucosa, raspberry-like tongue, conjunctival injection, and generalized polymorphous exanthema. The diagnosis of MIS-C was made. On the third day of hospitalization appeared facial asymmetry, right hemiplegia, hypotonia, osteotendinous reflexes 2/4, right positive Babinski, decreased muscle strength 1/5, dysarthria and paresis of the VII. A brain computerized tomography (CT) scan shown diffuse hypodensity at the level of the caudate nucleus, predominantly in the left parietal region, lenticular ganglion, anterior and posterior arm of the internal capsule on the left side. Based on the diagnosis of acute ischemic stroke, treatment was started with acetylsalicylic acid, enoxaparin, captopril and physiotherapy and rehabilitation. In the following days, the evolution was favorable. He was discharged with remarkable clinical improvement; in his outpatient controls, only a slight decrease of strength in the right hand was evidenced. The child has shown clinical improvement and is at home attending to his controls. Conclusions: It is important to keep in mind that children can develop a multisystem inflammatory syndrome and complications such as ischemic stroke, which requires early recognition and diagnosis to initiate timely treatment.