Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case Series
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : SR01 - SR04 Full Version

Rare Neurological Presentations of Paediatrics COVID-19 Cases Reported at a Tertiary Care Hospital in Mizoram, India

Published: November 1, 2022 | DOI:
F Elizabeth Lalhmangaihzuali, Wendy L Ralte, C Lalrintluangi, Zonuntluangi Khiangte, Ganesh Shanmugasundaram Anusuya

1. Associate Professor, Department of Paediatrics, Zoram Medical College, Aizawl, Mizoram, India. 2. Associate Professor, Department of Radiology, Zoram Medical College, Aizawl, Mizoram, India. 3. Assistant Professor, Department of Paediatrics, Zoram Medical College, Aizawl, Mizoram, India. 4. Assistant Professor, Department of Paediatrics, Zoram Medical College, Aizawl, Mizoram, India. 5. Professor, Department of Community Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, India.

Correspondence Address :
Dr. Ganesh Shanmugasundaram Anusuya,
Professor, Department of Community Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai, India.


Apart from the regular respiratory symptoms, neurological manifestations like headache, encephalopathy, encephalitis, seizure, coma, demyelinating disorders, and aseptic meningitis has been seen in paediatric Coronavirus Disease-2019 (COVID-19) positive cases. The present case series is about three children, of age range 9 to 15 years, who presented with encephalitis between January 2022- February 2022. All the children tested positive for COVID-19, either by Rapid Antigen Test (RAT) or by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). One patient had necrotising encephalitis like changes in the MRI neuroimaging of the brain, but negative Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ribonucleic Acid (RNA) PCR in Cerebrospinal Fluid (CSF). The second patient’s Magnetic Resonance Imaging (MRI) brain was suggestive of acute encephalopathy, but with normal CSF analysis. The third patient presented with clinical findings suggestive of encephalitis with normal CSF study and normal MRI. The children were managed with antipyretics, antiepileptics, antibiotics, and antiviral, injection mannitol, and steroids. After the completion of the treatment, all the children were alive and were discharged from the hospital.


Altered sensorium, Coronavirus, Encephalitis, Encephalopathy, Outcome

The primary target of SARS-CoV-2 is the respiratory system, but neurological manifestations like encephalopathy, headache, seizure, coma, altered sensorium, encephalitis, and aseptic meningitis have been reported in the COVID-19 positive paediatric patients (1),(2),(3),(4),(5),(6). The first neurological symptoms with SARS-CoV-2 were reported in March 2020 (7) with a positive specific SARS-CoV-2 RNA in CSF followed by multiple reports of SARS-CoV-2 associated encephalitis, with only few showing viral detection in the CSF. The entry of mechanism can be through haematogenous dissemination via endothelial cells or via the cribriform plate and olfactory bulb (8). The present case series is about three cases of CNS involvement of SARS-CoV-2 infection in children, without any respiratory symptoms.

Case Report

Case 1

A previously healthy 9-year-old girl presented to the local Primary Health Centre with repeated episodes of convulsions (generalised tonic clonic) with neck rigidity, altered sensorium, projectile vomiting (three episodes), and two days history of fever. The child tested positive for SARS-CoV-2 by RAT. She was then, immediately referred to Zoram Medical College (ZMC) after initiating emergency medications (inj. midazolam for convulsion, inj. paracetamol for fever and intravenous (i.v.) fluid dextrose normal saline).

The child presented to the hospital with generalised tonic clonic seizure, Glasgow Coma Scale (GCS) score ranged from 8 to 9, muscle power were: left upper and lower limb 3/5 each, right upper and lower limb 1/5. Muscle tone was decreased in all the four limbs. Deep tendon reflexes were decreased in all the limbs. Plantar reflex was extensor response on right and flexor response on left side. Both pupils were normal in size and reaction. RT-PCR from nasopharyngeal swab was positive for SARS CoV-2. Fundus examination was normal with no signs of papilloedema. The child was given inj. mannitol 20%, inj. leveteracetum, inj. methylprednisolone and inj. cefotaxime. The CSF analysis showed white cell count (WCC) of 2/mm3 (smear was scanty cellular, no atypical cell seen) and CSF protein was 33 mg/dL. CSF RT-PCR for SARS-CoV-2 RNA was negative. The CSF for Acid Fast Bacilli (AFB) and Gram stain were negative. There was no growth after 72 hours of incubation for both aerobic and anaerobic culture. The blood parameters were not suggestive of Multisystem Inflammatory Syndrome in Children (MIS-C).

The MRI brain showed a heterogeneous mass in both thalami on Susceptibility Weighted Imaging (SWI), bilateral symmetrical areas of diffuse restriction in both thalami on Diffusion Weighted Imaging (DWI), the classic acute necrotising appearance of “tricolour/target-like appearance” or “concentric/laminar structure” in both thalami, hyperintense signals in both thalami on T2 weighted image (T2WI), multiple foci of gyral oedema, bilateral cerebellar and dorsum of brainstem involvement on T2WI. The MRI findings were consistent with necrotising encephalitis (Table/Fig 1)a,b,c,d,e,f. (Table/Fig 1)g,h shows bilateral cerebellar and dorsum of brainstem involvement on T2WI respectively. Following therapy, the patient showed clinical and neurological improvement. Her muscular weakness improved and the patient started taking orally. She was discharged on 10th day without any focal neurological deficit. The laboratory findings are shown in (Table/Fig 2).

Case 2

A previously healthy 13-year-old boy presented at a primary health centre with altered sensorium, seizures and two days history of fever. The boy was referred to the Institute (tertiary hospital). He showed positivity for SARS-CoV-2 rapid antigen.

On the way to the hospital, his consciousness deteriorated and became unresponsive. On admission, his vitals were unstable pulse rate 138 per minute, respiratory rate 24/minute, blood pressure 100/80 mmHg, temperature 101° F, room air SpO2 was 85%.

On Central Nervous System (CNS) examination, both pupils were equal in size and reactive to light; no cranial nerve palsy or neck rigidity. All the deep tendon reflexes were normally elicitable. Plantar reflex was flexion response on both side. The fundus examination showed no papilloedema. The boy had GCS of 10 (E4V1M5). He did not require intubation. The patient was started on injection remdesivir, inj. dexamethasone, empirical i.v. antibiotics, and levetiracetam immediately on reaching to our Paediatrics Intensive Care Unit (PICU). Nasopharyngeal RT-PCR was tested positive for SARS-CoV-2 at time of admission. CSF analysis are showed in (Table/Fig 3) and was negative for SARS-CoV-2 RNA. The contrast MRI brain showed cortical enhancement in left frontal lobe on T2 and Fluid Attenuated Inversion Recovery (FLAIR) images suggestive of acute encephalopathy (Table/Fig 4).

The patient responded to the treatment. On the third day, the child became conscious, there was no episode of convulsion, he could sit without support, walk with support and he could take semi-solid diet. The boy was discharged on the 7th day after completion of the dose of remdesivir. At the time of discharge, he was active, stable, no focal neurological defecit and was accepting food orally.

Case 3

A previously healthy 15-year-old male presented at a district hospital with fever associated with headache for four days, mulitple episodes of seizures for three days and altered sensorium for one day. The patient was found positive for RAT for SARS-CoV-2 and then referred to the tertiary centre Zoram Medical College (ZMC). The patient reached the Institute after three hours of journey, during which his consciousness deteriorated.

On admission, the patient had altered sensorium vitals Heart Rate (HR) 140/minute, Temperature 102°F, Blood Pressure (BP) 100/ 80 mmHg, Room Air SPO2 85%. He was drowsy with GCS -- E1V2M5, with GCS scores 8/10, neck rigidity was present. There were no signs of dehydration, his pupils were equal in size and bilaterally reactive to light; he had no cranial nerve palsies, plantar bilateral were extensors response and the deep tendon reflex on knee bilateral were 3+, ankles bilateral were 3+, The fundus examination showed no papilloedema. He was managed with intravenous antibiotic (ceftriaxone), inj. paracetamol, inj. dexamethasone, inj. 20% mannitol and inj. phenytoin, immediately on reaching to the (PICU). Nasopharyngeal RT-PCR was positive for SARS-CoV-2 at time of admission. Lumbar puncture was done on the next day of admission and CSF analysis showed in (Table/Fig 5) and was negative for SARS-CoV-2 RNA. The MRI brain showed normal findings. The child responded to the medical treatment. The child regained consciousness next day and there was no episode of convulsion, he could sit without support. He could walk with support on the 3rd day. Rest of the hospital stay was uneventful. The boy was discharged on the 10th day. Patient was well and had no neurological deficit at the time of discharge.


The virus enters the lungs via Angiotensin-Converting Enzyme 2 (ACE-2) receptor for SARS-CoV-2 and the virus uses the Transmembrane protease, serine 2 (TMPRSS2) for S protein priming (8). Recent studies have demonstrated that SARS-CoV-2 exhibits neurotropic properties (9),(10). A direct neuroinvasive effect of the virus could be explained by its retrograde movement along the olfactory or the peripheral lung nerves to the CNS or via haematogenic migration through the CNS endothelia that express ACE-2 receptors. An indirect effect can result from the leakage of inflammatory mediators through a permeable blood-brain barrier (11).

Neither of three patients had respiratory symptoms or signs of MISC/PIMS-TS (Multisystem Inflammatory, Syndrome, in Children/Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2) or history suggestive of SARS-CoV-2 infection prior to the present infection. The symptoms of encephalopathy, muscle weakness, and reduced reflexes of the 1st case was in consistent with the findings of Tandon M et al., (12). However, the latter study was a systematic review and the age of the study population was greater than 18 years.

The temporal sequence of signs of encephalopathy and neurological symptoms, in a known COVID-19 infection, along with the later MRI brain changes as seen in the first two cases are suggestive of neuroinflammatory process triggered by SARS-CoV-2. The laboratory parameters and the MRI brain findings of the 1st case was similar to the case presented by Lazarte-Rantes C et al., (13) and Tandon M et al., (12). The study by Tandon M et al., in a systematic review of CSF findings of 113 patients from 67 studies (12). The CSF protein levels were elevated in 74.5% (38/51) patients with non-severe COVID-19 and 68.6% (24/35) in those with a severe COVID-19 infection.

All the three cases showed reduced pleocytosis in the CSF, and it was common to see MRI changes during the acute phase of the encephalopathic illness rather than during the recovery phase which was similar with the findings by Ellul MA et al., (6) and Tandon M et al., (12). The normal MRI findings in patients having CNS manifestation with COVID-19 infection had been reported (13).

None of the patients had any other positive viral markers except for SARS-CoV-2. In all the index patients, other infectious causes with CNS manifestations were excluded. As all the three patients had no laboratory findings suggestive of MISC, it was concluded that, these patients had COVID-19 infections with rare neurological manifestations.


Although, SARS-CoV-2 can trigger an inflammatory process which can present as encephalitis features clinically, it is important to exhaust all means of investigations before labelling an encephalopathy as acute COVID-19 encephalitis. Paediatricians need to be aware of this association in paediatrics patients with COVID-19 presenting to the emergency room with neurologic symptoms and clinical worsening. Though acute necrotising encephalitis associated with SARS-CoV-2 due to autoimmune-mediated mechanisms has been described in the adult population, children could also be at risk of developing this disease, following COVID-19 infection.

The SARS-CoV-2 CSF RNA test was negative in all the three cases. The detection of anti-SARS-CoV-2 antibodies in CSF could have supported the diagnosis of patients with COVID-19 encephalitis, but this facility was unavailable in the study centre.


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Lazarte-Rantes C, Guevara-Castañón J, Romero L, Guillén-Pinto D. Acute necrotizing encephalopathy associated with sars-cov-2 exposure in a pediatric patient: Cureus. 2021;13(5):e15018. Doi: 10.7759/cureus.15018. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/58481.17013

Date of Submission: Jul 18, 2022
Date of Peer Review: Aug 24, 2022
Date of Acceptance: Sep 23, 2022
Date of Publishing: Nov 01, 2022

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Jul 19, 2022
• Manual Googling: Sep 18, 2022
• iThenticate Software: Sep 21, 2022 (20%)

ETYMOLOGY: Author Origin

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