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Children diagnosed with Covid-19 pediatric multisystem inflammatory syndrome, or PMIS, may develop new neurological problems without any of the respiratory issues commonly associated with the virus, according to a study published Wednesday in the Journal of the American Medical Association. 

Researchers examined 27 children with Covid-19 PMIS, who were previously healthy, between March 1 and May 8 at Great Ormond Street Hospital for Children in London, England. They found that of the 27 patients, four experienced new neurological symptoms.

Symptoms included impaired brain function, headaches, brainstem and cerebellar issues, muscle weakness and reduced reflexes. All four patients required admission to the intensive care unit for treatment. 

Although the study is small, researchers say the results show the coronavirus can also cause neurological damage in children — not just adults — without any of the respiratory symptoms that have become a hallmark indicator of Covid-19. 

Neurological issues have been previously reported in adults with the coronavirus. The paper cites a different study published in May on the Wiley Online Library that examined 214 coronavirus patients in Wuhan, China. Of those patients, 78 experienced neurological symptoms, which included dizziness, headache, impaired consciousness, acute cerebrovascular disease, seizures and ataxia, which mimics being drunk, with slurred speech and stumbling.

Researchers of the pediatric study observed splenium signal changes in the corpus callosum area of the brain, or lesions on the brain, in the four patients. They said although these findings are not specific to SARS-CoV-2, clinicians should consider the virus when diagnosing children who have new neurological symptoms.

Moreover, scientists emphasized that since respiratory symptoms were uncommon among PMIS patients, clinicians should suspect Covid-19 in children who show new neurological problems without any other symptoms.

In April, health officials first observed a rise in coronavirus cases in children who developed a rare inflammatory condition. Symptoms of PMIS were similar to that of Kawasaki syndrome, which causes swelling of the heart’s blood vessels and mainly affects children under the age of 5.

The World Health Organization had announced that it would investigate whether there is a relationship between Covid-19 and the inflammatory conditions. Since then, no new symptoms or inflammatory disease have been reported in children infected with the coronavirus.

Scientists have said that young adults are less likely to become severely ill than older adults, according to early findings on the virus. However, this new study shows that despite the typically mild acute infection, children may be at a high risk of a secondary inflammatory syndrome.