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Wei C, Yang DP, Yang Y, Yang WH, Lu YM, Yu XP, Chang S. Visual and auditory attention defects in children with intermittent exotropia. Ital J Pediatr 2024; 50:17. [PMID: 38273409 PMCID: PMC10809432 DOI: 10.1186/s13052-024-01591-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/07/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Previous studies have shown that children with intermittent exotropia (IXT) have a higher rate of psychiatric abnormalities as they grow up, such as attention deficit. This study explored visual and hearing attention among children with IXT, and evaluated its association with clinical characteristics and cognitive development. METHODS Forty-nine children with a diagnosis of IXT and 29 children with traditional development were recruited. The Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) was used to measure the subjects' full-scale response control quotient (FSRCQ), full-scale attention quotient (FSAQ), auditory response control quotient (ARCQ), auditory attention quotient (AAQ), visual response control quotient (VRCQ), and visual attention quotient (VAQ). The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) was used to assess their cognitive function. The differences between the scores of children with IXT and normal controls were analyzed. RESULTS The results showed that the FSRCQ, FSAQ, ARCQ, AAQ, VRCQ, and VAQ of children with IXT were all lower than those of normal controls with the same age (P < 0.05). The level of attention was significantly correlated with the age of strabismus onset (P < 0.05), but not with the degree of strabismus, stereopsis, or fusion control score. In addition, audiovisual attention was correlated significantly with their cognitive development level. The random forest classifier prediction model showed that age of strabismus onset was an important predictor of attention. CONCLUSION Children with IXT have lower visual and auditory attention and control than their peers, and the age of onset of strabismus may be a major factor.
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Affiliation(s)
- Cong Wei
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong, China
| | - Ding-Ping Yang
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yan Yang
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wen-Han Yang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Ya-Mei Lu
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong, China
| | - Xin-Ping Yu
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Shuai Chang
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Bozzola E, Caffarelli C, Santamaria F, Corsello G. Year 2022: exploring COVID-19 pandemic in children. Ital J Pediatr 2023; 49:128. [PMID: 37770981 PMCID: PMC10540415 DOI: 10.1186/s13052-023-01536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
COVID-19 pandemics is rapidly changing. In this article, we review progresses published in the Italian Journal of Pediatrics in 2022. More data on clinical pictures, prevention strategies and active management in children have been provided. The continued evolution of knowledge has driven transformations in the clinical approach to the disease and allowed key advancements in the care of children with COVID-19.
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Affiliation(s)
- Elena Bozzola
- Pediatric Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Carlo Caffarelli
- Department of Medicine and Surgery, Clinica Pediatrica, Azienda Ospedaliera-Universitaria, University of Parma, Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
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Xue H, Zeng L, He H, Xu D, Ren K. Autoimmune encephalitis in COVID-19 patients: a systematic review of case reports and case series. Front Neurol 2023; 14:1207883. [PMID: 37771454 PMCID: PMC10525333 DOI: 10.3389/fneur.2023.1207883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
Background There is mounting evidence suggesting that autoimmune encephalitis (AE) can be observed as a neurological complication in patients with COVID-19. This review aimed to summarize the clinical manifestations, types, and outcomes of COVID-19-associated AE. Methods A systematic search was conducted in the PubMed, Embase, and Web of Science databases to identify case reports and case series related to COVID-19-associated AE from 1 January 2020 to 31 March 2023. After a thorough screening and evaluation, irrelevant articles were excluded. Relevant information concerning types, clinical manifestations, and outcomes was extracted and synthesized. Results A total of 37 studies, comprising 34 case reports and 3 case series, were included in this review. Among the 42 COVID-19-associated AE patients, 21 (50%) cases were classified as an unknown antibodies (Ab) type of COVID-19-associated AE, 10 (23.80%) cases as anti-N-methyl-D-aspartate (NMDA) encephalitis, 4 (9.5%) cases as limbic encephalitis, and 3 (7.1%) cases as anti-myelin-oligodendrocyte-glycoprotein encephalitis, along with other rare types of AE. Disturbance of consciousness, seizures, and psychiatric symptoms were identified as the main clinical manifestations of COVID-19-associated AE. While the symptoms of AE displayed variation, most patients achieved full recovery although a few experienced residual symptoms of neurological damage. Conclusion This systematic review comprehensively describes the characteristics of COVID-19-associated AE. The main type of COVID-19-associated AE identified in this study is an unknown Ab type of COVID-19-associated AE. Despite the potentially life-threatening risks of COVID-19-associated AE, the majority of patients survived, with some patients reporting residual neurological symptoms.
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Affiliation(s)
- Hua Xue
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Li Zeng
- Department of Respiratory, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Hongxian He
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Dongxun Xu
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Kaixin Ren
- Department of Rehabilitation, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
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Khor HD, Lott PW, Daman Huri SNR, Singh S, Iqbal T. COVID-19 and Crossed Eye: A Case Report and Literature Review. Cureus 2023; 15:e42722. [PMID: 37654949 PMCID: PMC10466450 DOI: 10.7759/cureus.42722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
This study aims to report a case of neuro-ophthalmic manifestation in a coronavirus disease 2019 (COVID-19) patient and a literature review of neuro-ophthalmological manifestation in COVID-19 patients. A 57-year-old male presented with headache, giddiness, and sudden onset of diplopia over two days after having a flu-like illness. Clinical examination revealed bilateral bizarre extraocular movement with right lower motor neuron facial nerve palsy. A polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive. Computed tomography (CT) and contrast-enhanced CT of the brain and CT venography were unremarkable. Magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography of the circle of Willis, and MRI of the internal auditory meatus revealed a subacute pontine infarction with no leptomeningeal or cranial nerve enhancement and a normal circle of Willis. The patient received a course of oral prednisolone and clinical symptoms improved gradually. Articles published between December 2019 and June 2022 were included. A total of 23 cases, with 14 male and nine female patients, were summarized. The mean age at presentation was 46.95 years (range = 9-71 years), with the most affected age group ranging from 31 to 70 years (17 of 23 cases, 73.91%). Neuro-ophthalmological symptoms and signs can be isolated or associated with neurological syndromes. The manifestations include optic neuritis, isolated or multiple cranial nerve palsies, acute vision loss, Miller Fisher syndrome, myasthenia gravis, acute disseminated encephalomyelitis, Guillain-Barré syndrome, internuclear ophthalmoplegia, and cerebrovascular events. Diagnosing neuro-ophthalmic complications secondary to SARS-CoV-2 infection is challenging, as there are no pathognomonic symptoms to detect the disease. High clinical suspicion aids in early diagnosis and initiation of treatment may help in relieving the symptoms.
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Affiliation(s)
- Hui Di Khor
- Department of Ophthalmology, Faculty of Medicine, Universiti Malaya Eye Research Centre, Kuala Lumpur, MYS
| | - Pooi Wah Lott
- Department of Ophthalmology, Faculty of Medicine, Universiti Malaya Eye Research Centre, Kuala Lumpur, MYS
| | | | - Sujaya Singh
- Department of Ophthalmology, Faculty of Medicine, Universiti Malaya Eye Research Centre, Kuala Lumpur, MYS
| | - Tajunisah Iqbal
- Department of Ophthalmology, Faculty of Medicine, Universiti Malaya Eye Research Centre, Kuala Lumpur, MYS
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Spiteri R, Barakat S, Vukicevic M. COVID-19 and sudden-onset ocular neurogenic palsy in prior healthy patients: a systematic review. Strabismus 2023; 31:145-151. [PMID: 37448224 DOI: 10.1080/09273972.2023.2232419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND The aim of this systematic review is to identify cases of neurogenic ocular palsy in the presence of COVID-19 and to document patient characteristics, type of palsy and possible aetiologies. METHODS A systematic search of PubMed, Medline and CINAHL databases was conducted on the 6th of January 2023 to identify cases of neurogenic ocular palsy in patients with current or previous COVID-19 infection. Data were pooled to summarise the neurogenic palsy, patient clinical characteristics and proposed palsy mechanisms. RESULTS The combined database search yielded 1197 articles. Of these, 23 publications consisting of 25 patients met the inclusion criteria. Most patients were male (68%) and ranged in age from 2 to 71 years (median=32.7, SD=21.4). Seven patients (28%) were children aged 2 to 10 years old. Abducens palsies were most common (68%) and the most common ocular presentation was diplopia (76%) with an average time of onset 15 days from testing positive to COVID-19 or having symptoms of the virus. Proposed mechanism of development of a neurogenic palsy secondary to COVID-19 infection was classified into one of three categories: vascular/thrombotic, a viral neuro-invasive or inflammatory virus-mediated immune response. DISCUSSION This study suggests that COVID-19 infection may be linked to oculomotor, trochlear and abducens nerve palsies and the underlying mechanisms may vary but are difficult to definitively establish. Further studies investigating the onset of neurogenic palsy secondary to COVID-19 infection is required.
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Affiliation(s)
- Ryan Spiteri
- Discipline of Orthoptics, School of Allied Health Human Services and Sport, La Trobe University, Melbourne
| | - Sousann Barakat
- Discipline of Orthoptics, School of Allied Health Human Services and Sport, La Trobe University, Melbourne
| | - Meri Vukicevic
- Discipline of Orthoptics, School of Allied Health Human Services and Sport, La Trobe University, Melbourne
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Perilli L, Fetta M, Capponi M, Guido CA, Grosso S, Iannetti P, Spalice A. Peripheral nervous system involvement in SARS-CoV-2 infection: a review of the current pediatric literature. Front Neurol 2023; 14:1134507. [PMID: 37305745 PMCID: PMC10249431 DOI: 10.3389/fneur.2023.1134507] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/19/2023] [Indexed: 06/13/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the pathogen responsible for the pandemic health emergency declared by the World Health Organization in March 2020. During the first part of the pandemic, adults showed mild to severe respiratory symptoms. Children seemed initially exempt, both from acute and subsequent complications. Hyposmia or anosmia were promptly identified as the main symptoms of acute infection, so neurotropism of SARS-CoV-2 was immediately suspected. (1, 2). As the emergency progressed, post infectious neurological complications were described also in pediatric population (3). Cases of cranial neuropathy in connection with acute SARS-CoV-2 infection have been reported in pediatric patients, as an isolate post infectious complication or in the context of the multisystem inflammatory syndrome in children (MIS-C) (4-6). Neuroinflammation is thought to be caused by several mechanisms, among which immune/autoimmune reactions (7), but so far, no specific autoantibody has been identified. SARS-CoV-2 can enter the central nervous system (CNS) directly and/or infect it retrogradely, through the peripheral nervous system (PNS), after replicating peripherally; several factors regulate invasion and subsequent neuroinflammation. Indeed, direct/secondary entry and replication can activate CNS-resident immune cells that, together with peripheral leukocytes, induce an immune response and promote neuroinflammation. In addition, as we will discuss in the following review, many cases of peripheral neuropathy (cranial and non-cranial) have been reported during or after SARS-CoV-2 infection. However, some authors have pointed out that the increase of cranial roots and ganglia in neurological imaging is not always observed in children with cranial neuropathy. (8). Even if a variety of case reports were published, opinions about an increased incidence of such neurologic diseases, linked to SARS-CoV-2 infection, are still controversial (9-11). Facial nerve palsy, ocular movements abnormalities and vestibular alterations are among the most reported issues in pediatric population (3-5). Moreover, an increased screen exposure imposed by social distancing led to acute oculomotion's disturbance in children, not primarily caused by neuritis (12, 13). The aim of this review is to suggest food for thought on the role of SARS-CoV-2 in neurological conditions, affecting the peripheral nervous system to optimize the management and care of pediatric patients.
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Affiliation(s)
- Lorenzo Perilli
- Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Marina Fetta
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Martina Capponi
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Cristiana Alessia Guido
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Salvatore Grosso
- Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Paola Iannetti
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
| | - Alberto Spalice
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Lazio, Italy
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Dinkin M, Sathi S. Efferent neuro-ophthalmic complications of coronavirus disease 2019. Curr Opin Ophthalmol 2022; 33:471-484. [PMID: 36165417 DOI: 10.1097/icu.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We set out to describe efferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We describe syndromes affecting ocular motility and elaborate on mechanisms of disease, including para-infectious inflammation, hypercoagulability, endothelial damage, and direct neurotropic viral invasion. Despite global vaccination programs, COVID-19 continues to pose an international threat that may rarely result in diplopia or nystagmus. RECENT FINDINGS Efferent complications include cranial nerve palsies leading to diplopia, either isolated or in association with Miller Fisher syndrome. Nystagmus has been observed in the setting of hemorrhagic acute necrotizing encephalopathy and brainstem infarcts, and opsoclonus syndrome has been described. SUMMARY Observed neuro-ophthalmic associations need to be confirmed through larger comparative studies. Meanwhile, the range of possible complications should be recognized by neurologists and ophthalmologists alike, to facilitate faster diagnosis and treatment of both COVID-19 and its neuro-ophthalmic manifestations.
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Affiliation(s)
- Marc Dinkin
- Departments of Ophthalmology and Neurology, Weill Cornell Medical College
| | - Swetha Sathi
- M2, Weill Cornell Medical College, New York, New York, USA
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Škunca Herman J, Marić G, Ravlić MM, Knežević L, Jerković I, Sušić E, Marić V, Vicković IP, Vatavuk Z, Polašek O. Diplopia, COVID-19 and Vaccination: Results from a Cross-Sectional Study in Croatia. Vaccines (Basel) 2022; 10:vaccines10091558. [PMID: 36146636 PMCID: PMC9503164 DOI: 10.3390/vaccines10091558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/30/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to explore diplopia as a symptom of undetected COVID-19 infection or as a possible side effect of COVID-19 vaccination. We examined 380 patients with diplopia admitted to the Department of Ophthalmology of the University Hospital Centre Sestre milosrdnice in Zagreb, Croatia, from July 2020 to June 2022. After excluding patients with confirmed organic underlying diplopia causes or monocular diplopia, we linked the patient information with the national COVID-19 and vaccination registries. Among the 91 patients included in this study, previously undetected COVID-19 infection as the possible cause of diplopia was confirmed in five of them (5.5%). An additional nine patients (9.9%) were vaccinated within one month from the onset of their symptoms, while the remaining 77 had neither and were therefore considered as controls. The breakdown according to the mechanism of diplopia showed no substantial difference between the vaccinated patients and the controls. We detected marginally insignificant excess abducens nerve affection in the COVID-positive group compared with that in the controls (p = 0.051). Post-vaccination diplopia was equally common in patients who received vector-based or RNA-based vaccines (21.4 vs. 16.7%; p = 0.694). COVID-19 testing should be performed for all cases of otherwise unexplained diplopia. The risk of post-vaccination diplopia was similar in both types of vaccines administered, suggesting a lack of evidence linking specific vaccine types to diplopia.
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Affiliation(s)
- Jelena Škunca Herman
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Goran Marić
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Maja Malenica Ravlić
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Lana Knežević
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Ivan Jerković
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Ena Sušić
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Vedrana Marić
- Croatian Institute of Public Health, 10000 Zagreb, Croatia
| | - Ivanka Petric Vicković
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Zoran Vatavuk
- Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia
| | - Ozren Polašek
- Department of Public Health, University of Split School of Medicine, 21000 Split, Croatia
- Algebra LAB, Algebra University College, 10000 Zagreb, Croatia
- Correspondence:
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