key: cord-318979-1t68f5pp
authors: Kihira, Shingo; Morgenstern, Peter F.; Raynes, Hillary; Naidich, Thomas P.; Belani, Puneet
title: Fatal cerebral infarct in a child with COVID-19
date: 2020-07-23
journal: Pediatr Radiol
DOI: 10.1007/s00247-020-04779-x
sha: 
doc_id: 318979
cord_uid: 1t68f5pp

nan

because of recent COVID-19 infection. He underwent venoarterial extracorporeal membrane oxygenation (ECMO) cannulation. Over the next 4 days his condition improved. Hours prior to decannulation, his right pupil became dilated and nonreactive to light. Emergent decannulation was performed and a head CT (Fig. 1 ) revealed a large acute right anterior and middle cerebral artery territory infarction and subarachnoid hemorrhage in the left hemisphere. Immediately following CT scan his left pupil became fixed and dilated. Sugammadex was administered for rapid reversal of his residual vecuronium paralysis. Neurologic exam demonstrated Fig. 1 Axial non-contrast head CT in a 5-year-old boy with recent COVID-19 infection demonstrates massive right anterior and middle cerebral artery infarction (asterisk) and subarachnoid hemorrhage in the left hemisphere (arrows) absent corneal, gag and pupillary responses and no movement to painful stimuli. After discussion with his family no surgical decompression was attempted because of his clinical condition. He was declared brain dead 3 days later.

This is an unfortunate case of a healthy 5-year-old boy with COVID-19 infection complicated by cardiogenic shock and hypercoagulable state. The combination of cardiogenic shock and hypercoagulable state presumably contributed to the massive cerebral infarction, with the contributing role of ECMO cannulation uncertain. It is our hope that this case informs caregivers and imagers of a potentially devastating neurologic manifestation of COVID-19.

Conflicts of interest None

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