Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Michael Weinstock

Abstract

Objective:In addition to experiencing classic respiratory symptoms, pediatric COVID-19 patients have presented with neurological manifestations including cranial nerve dysfunction. The evidence regarding these presentations has yet to be synthesized, and the aim of this work was to determine how commonly cranial neuropathies are associated with pediatric COVID-19 cases and what the prognosis is for these children. Methods: A systematic review was conducted using a comprehensive search strategy of OVID Medline, OVID Embase, and Web of Science databases. The inclusion criteria were research articles that described pediatric COVID-19 patients with cranial nerve involvement. Results: The search yielded 5497 articles. Thirty-four (34/5497) articles were included, across which there were 3192 laboratory-confirmed COVID-positive pediatric patients. Olfactory and gustatory dysfunction were most frequently examined (67.6% (23/34) of the included studies) and were categorized by their inclusion criteria. The pooled incidence of olfactory dysfunction was 7.5% (95% CI: 0.7%-80.9%) for hospitalized patients, 14.2% (95% CI: 5.7%-35.5%) for symptomatic patients, and 10.6% (95% CI: 5.3%-21.1%) for all patients with positive test. Follow-up was available for 39.5% (131/332) of olfactory dysfunction cases, and 93.1% (122/131) recovered their smell. Isolated cranial neuropathies were present in 15 cases, and there were also three cases of cranial nerve polyneuropathy. For isolated cranial neuropathies, follow-up was available for 80.0% (12/15), of which 75.0% (9/12) experienced full clinical resolution. Conclusion: The present study is the largest pooling of data regarding cranial neuropathies associated with pediatric COVID-19. As expected, olfactory and gustatory dysfunction were the most common, but several other cranial neuropathies have also been documented in the literature.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 06/29/2024

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