Russian Journal of Child NeurologyRussian Journal of Child NeurologyРусский журнал детской неврологии2073-88032412-9178Publishing House ABV Press39810.17650/2073-8803-2022-17-2-47-54CLINICAL OBSERVATIONSКЛИНИЧЕСКИЕ НАБЛЮДЕНИЯIschemic stroke in a pediatric patient: complication of the course of COVID-19 (clinical case and literature review)Ишемический инсульт в детском возрасте: осложнение течения COVID-19 (описание клинического случая и обзор литературы)ShchetininaA. M.ЩетининаА. М.
Russian Federation

Alena Mikhaylovna Shchetinina

2 Akkuratova St., Saint Petersburg 197341

Алена Михайловна Щетинина

197341, Санкт-Петербург, ул. Аккуратова, 2

anela1993@mail.ruIvanovV. P.ИвановВ. П.
Russian Federation

2 Akkuratova St., Saint Petersburg 197341

197341, Санкт-Петербург, ул. Аккуратова, 2

KimA. V.КимА. В.
Russian Federation

2 Akkuratova St., Saint Petersburg 197341

197341, Санкт-Петербург, ул. Аккуратова, 2

IvanovaG. G.ИвановаГ. Г.
Russian Federation

4 Prospekt Kultury, Saint Petersburg 194291

194291 Санкт-Петербург, проспект Культуры, 4

MalkoV. A.МалькоВ. А.
Russian Federation

2 Akkuratova St., Saint Petersburg 197341

197341, Санкт-Петербург, ул. Аккуратова, 2

AlekseevaT. M.АлексееваТ. М.
Russian Federation

2 Akkuratova St., Saint Petersburg 197341

197341, Санкт-Петербург, ул. Аккуратова, 2

V.A. Almazov National Medical Research Centre, Ministry of Health of RussiaФГБУ «Национальный медицинский исследовательский центр им. B. A. Алмaзoвa» Минздрава РоссииL.G. Sokolov Northwestern Research and Clinical Center, Federal Medical and Biological AgencyФГБУ «Северо-Западный окружной научно-клинический центр им. Л. Г. Соколова» Федерального медико-биологического агентства1504202217247541309202213092022Copyright ©; 2022, ABV-PressCopyright ©; 2022, АБВ-пресс2022ABV-PressАБВ-прессhttps://rjdn.abvpress.ru/jour/about/editorialPolicieshttps://rjdn.abvpress.ru/jour/article/view/398

Recently, there is a growing number of publications about the complicated course of the COVID-19 in children. The literature describes only a few cases of acute cerebrovascular diseases. In the case described in this paper, an 11‑year-old boy presented with COVID-19 complicated by an ischemic stroke. Moderate ischemic stroke (pedNIHSS 14 points) occurred on the 7th day after infection with the SARS-CoV-2 and the background of the multisystem inflammatory syndrome. It has started with the left hemiplegia, hemianesthesia, central-type facial moderate palsy, and pseudobulbar palsy. Focal brain ischemia in the right hemisphere brain and occlusion of the right middle cerebral artery was confirmed by neuroimaging data. The treatment observed regression of neurological symptoms: there were minimal movements in his left arm and leg, facial muscles, also improved gulping and speech. After 1.5 months, the stroke was provided clinical examination: no markers predisposing to hypercoagulability or a prothrombotic state, as well as markers of systemic diseases. According to neuroimaging data, was occurred recanalization of occluded middle cerebral artery, was postischemic changes. This case shows the possibility of stroke against the background of COVID-19 in children without somatic problems and makes the doctor more vigilant during the treatment of COVID-19.

В последнее время появляется все большее количество публикаций об осложненном течении новой коронавирусной инфекции у детей. В литературе описаны лишь единичные случаи острых нарушений мозгового кровообращения. В статье представлено описание клинического случая течения новой коронавирусной инфекции, осложненного ишемическим инсультом у мальчика 11 лет. Ишемический инсульт средней степени тяжести (pedNIHSS 14 баллов) возник на 7‑е сутки после инфицирования вирусом SARS-CoV-2, на фоне мультисистемного воспалительного синдрома, проявлялся левосторонней гемиплегией и гемигипестезией, центральным парезом мимической мускулатуры средней степени тяжести, а также псевдобульбарным синдромом. Методы нейровизуализации подтвердили наличие ишемического очага в правом полушарии головного мозга с окклюзией правой средней мозговой артерии. На фоне лечения отмечался регресс неврологической симптоматики: появились минимальные движения в левой руке и ноге, мимической мускулатуре лица, также улучшились глотание и речь. Спустя 1,5 мес после инсульта при обследовании не было выявлено маркеров, предрасполагающих к протромботическим состояниям, а также признаков системных заболеваний. По данным нейровизуализации произошла полная реканализация средней мозговой артерии, сохранялись изменения в постишемическом очаге. Данный случай показывает возможность развития острого нарушения мозгового кровообращения на фоне коронавирусной инфекции у соматически здоровых детей и заставляет врача быть более настороженным при лечении коронавирусной инфекции.  

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