Brains after Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Children


  • Urška Klančič University of Ljubljana
  • Mimi Klinec University of Ljubljana
  • Ema Vaupotič University of Ljubljana


Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition linked to COVID-19, typically developing 2–6 weeks after SARS-CoV-2 infection. Individual’s blood vessels, digestive system, skin, and/or eyes become swollen and irritated. Infected individuals, particularly children, are at heightened risk for cognitive and emotional deficits affecting memory, attention, information processing, and executive functions due to the virus’ impact on the central nervous system. Notably, negative neurological, and psychiatric outcomes in children with COVID-19 are reported [1] to be four times more frequent than in similarly diagnosed adults. This experimental study employs both structural and functional magnetic resonance imaging (fMRI)  to explore the potential cognitive and neural disruptions in children previously diagnosed with MIS-C. Of particular interest is the examination of the cortex and hippocampus.

The hypothesis posits that individuals (aged from 8 to 20 years) previously afflicted with MIS-C may exhibit prolonged reaction times during task-solving, or alternatively, reaction times may remain unaltered, accompanied by an increase in cognitive control. The experimental tasks, both performed inside the MR, include a cognitive control task, namely the AX-CPT task, customised for a younger population, where the typical letter stimuli AB (cues) and XY (targets) are replaced with images. Participants are instructed to provide responses as quickly as possible using a keypad. We measure their reaction times and the accuracy of their responses.

The second task focuses on assessing memory encoding and recall. In the initial phase, participants during MR imaging view image pairs of animals and their corresponding foods, tasked with envisioning the depicted animal consuming the food. Subsequently, their ability to recall the correct pair is assessed through a multiple-choice question. Our role in the experiment involves familiarising participants with the testing procedures and executing the entire protocol during MR imaging, in collaboration with radiological engineers. To optimise the protocol for paediatric MRI procedures, we have undertaken a comprehensive literature review before executing the protocol. This review aimed to identify and integrate best practices to enhance the MRI experience for children. It involved incorporating child-friendly adjustments and techniques to make the MRI process less intimidating and more comfortable, thereby facilitating smoother and more effective imaging sessions [2].

This study addresses an important gap in paediatric research by focusing on the cognitive consequences of SARS-CoV-2 infection in children and adolescents, a demographic often overlooked in existing literature. By documenting the severity of potential cognitive deficits, the research is expected to enhance psychological treatments, thus improving the functionality and subjective well-being of young patients.


[1] S. T. Ray et al., “Neurological manifestations of SARS-COV-2 infection in hospitalised children and adolescents in the UK: A prospective national cohort study,” The Lancet Child & Adolescent Health, vol. 5, no. 9, pp. 631–641, Sep. 2021. doi:10.1016/s2352-4642(21)00193-0 

[2]  Raschle, N. M. et al.,  “Making MR imaging child's play - pediatric neuroimaging protocol, guidelines and procedure,” Journal of visualized experiments, vol. 29, no. 1309. Jul. 2009. doi: 10.3791/1309