New onset of neuropsychiatric symptoms without any identifiable cause should raise the suspicion of the patient having Covid-19 or recent exposure to SARS-CoV-2. In a case series published in JAMA Neurology, researchers have described three pediatric patients with recent Covid-19, who required hospitalization for sudden neuropsychiatric symptoms. These patients lacked the typical systemic features of Covid-19.

All the three patients included had been admitted to hospital for subacute onset of functionally impairing behavioral symptoms ranging from severe anxiety to delusional psychosis. These symptoms showed rapid progression. These patients did not fulfil the criteria for multisystem inflammatory syndrome in children (MISC).

All the three patients had abnormal CSF with restricted oligoclonal bands, raised protein levels and/or an elevated IgG index. Two patients had intrathecal anti-SARS-CoV-2 antibodies; antineural antibodies were also detected on  mouse brain tissue immunostaining in two of the three patients. Besides antipsychotic medication, they were also given immunotherapy. The two patients with intrathecal anti-SARS-CoV-2 antibodies and antineural antibodies showed a modest to robust response to immunotherapy, while the third patient recovered without immunotherapy.

The neuropsychiatric symptoms in some patients may be immune-mediated as evident by the presence of intrathecal antineural autoantibodies indicative of “central nervous system autoimmunity in pediatric patients with COVID-19 and recent neuropsychiatric symptoms” despite no features of respiratory involvement  Such patients may respond to immunotherapy.

Reference

1. Christopher M Bartley, et al. Anti-SARS-CoV-2 and autoantibody profiles in the cerebrospinal fluid of 3 teenaged patients with COVID-19 and subacute neuropsychiatric symptoms. JAMA Neurol. 2021 Oct 25. doi: 10.1001/jamaneurol.2021.3821. Online ahead of print.