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Neuro-visual involvement has been reported in numerous patients with severe SARS-CoV-2 disease, mainly among adult patients. In children, such involvement has been reported in rare cases, often in those presenting with severe forms of COVID-19. The aim of this work is to explore the association between mild COVID-19 and neuro-visual manifestations in children. The authors report three cases of previously healthy children who developed neuro-visual manifestations following mild acute COVID-19, analysing the clinical phenotype, the latency between the onset of acute COVID-19 and neuro-visual involvement, and the kinetics of resolution. The patients developed different clinical patterns, including visual impairment and ophthalmoplegia. In two cases, these clinical features occurred during acute COVID-19, while in the third patient their development was delayed after 10 days from disease onset. Furthermore, the dynamics of resolution were different, with one patient showing remission after 24 hours, the second after 30 days and the third showing persistence of their strabismus after two months of follow-up. The spreading of COVID-19 among the paediatric population will probably lead to an increase of atypical disease forms, including those presenting with neuro-visual involvement. The authors conclude that a better knowledge of the pathogenic and clinical features of these manifestations is warranted.

Neurovisual manifestations in children with mild COVID-19: an association to remember.
Costagliola G, Vallario MP, Santangelo A, et al.
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Claire Howard

Salford Royal NHS Foundation Trust, Salford, UK.

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