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Volume 32, Number 2—February 2026

Synopsis

Life-Threatening SARS-CoV-2–Associated Encephalopathy and Multiorgan Failure in Children, Asia and Oceania, 2022–2024

Mariko Kasai1, Hiroshi SakumaComments to Author , Motomasa Suzuki1, Masahiro Nishiyama1, Nanako Kawata1, Jainn-Jim Lin1, Kuang-Lin Lin, Velda Han, Shekeeb S. Mohammad, Russell C. Dale, Terrence Thomas, Kazuhiro Muramatsu, Osamu Mitani, Yoshiyuki Kobayashi, Kouhei Ishida, Yuichi Abe, Ichiro Kuki, and Jun-ichi Takanashi
Author affiliation: Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan (M. Kasai, H. Sakuma); Aichi Children's Health and Medical Center, Aichi, Japan (M. Suzuki); Hyogo Prefectural Kobe Children’s Hospital, Kobe, Japan (M. Nishiyama); Tokyo Metropolitan Children’s Medical Center, Tokyo (N. Kawata); Chang Gung Children’s Hospital and Chang Gung Memorial Hospital, School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan (J.-J. Lin, K.-L. Lin); Khoo Teck Puat-National University Children’s Medical Institute, Singapore (V. Han); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (V. Han); Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia (V. Han, S.S. Mohammad, R.C. Dale); KK Women’s and Children’s Hospital, Singapore (T. Thomas); Jichi Medical University, Tochigi, Japan (K. Muramatsu); Fukuyama City Hospital, Hiroshima, Japan (O. Mitani); Hiroshima University Hospital, Hiroshima (Y. Kobayashi); Sapporo Medical University School of Medicine, Sapporo, Japan (K. Ishida); National Center for Child Health and Development, Tokyo (Y. Abe); Osaka City General Hospital, Osaka, Japan (I. Kuki); Tokyo Women’s Medical University Yachiyo Medical Center, Chiba, Japan (J. Takanashi)

Main Article

Figure 2

Brain computed tomography imaging for patients with SARS-CoV-2 acute shock with encephalopathy and multiorgan failure/acute fulminant cerebral edema (ASEM/AFCE) for study of life-threatening SARS-CoV-2–associated encephalopathy and multiorgan failure in children, Asia and Oceania, 2022–2024. A) Case-patient 1, showing diffuse cerebral edema (DCE) within 10 hours after onset of neurologic symptoms (left 2 images) and severe DCE and herniation at 18 hours after onset (right 2 images). B) Case-patient 6, showing mild cerebral edema within 4 hours after onset (left 2 images) and severe DCE at 23 hours after onset (right 2 images). C) Case-patient 15, showing DCE 3 hours after onset (left 2 images) and severe DCE with low-density involving the bilateral cerebral white matter and thalamus at 23 hours from the onset (right 2 images). D) Case-patient 19, showing DCE with low-density lesions in the bilateral cerebral white matter within 90 minutes after onset (left 2 images) and severe DCE at 10 hours after onset (right 2 images). E) Case-patient 18, showing mild cerebral edema on day 2 of illness; the patient had no further exacerbation of DCE. F) Case-patent 20, showing DCE with bilateral low-density lesions in the thalamus (left image) and periventricular cerebral white matter within 30 hours after onset (right image). G) Case-patient 23, showing DCE within 7 hours after onset (left image) and a high density of frontal subcortical white matter (right image).

Figure 2. Brain computed tomography imaging for patients with SARS-CoV-2 acute shock with encephalopathy and multiorgan failure/acute fulminant cerebral edema (ASEM/AFCE) for study of life-threatening SARS-CoV-2–associated encephalopathy and multiorgan failure in children, Asia and Oceania, 2022–2024. A) Case-patient 1, showing diffuse cerebral edema (DCE) within 10 hours after onset of neurologic symptoms (left 2 images) and severe DCE and herniation at 18 hours after onset (right 2 images). B) Case-patient 6, showing mild cerebral edema within 4 hours after onset (left 2 images) and severe DCE at 23 hours after onset (right 2 images). C) Case-patient 15, showing DCE 3 hours after onset (left 2 images) and severe DCE with low-density involving the bilateral cerebral white matter and thalamus at 23 hours from the onset (right 2 images). D) Case-patient 19, showing DCE with low-density lesions in the bilateral cerebral white matter within 90 minutes after onset (left 2 images) and severe DCE at 10 hours after onset (right 2 images). E) Case-patient 18, showing mild cerebral edema on day 2 of illness; the patient had no further exacerbation of DCE. F) Case-patent 20, showing DCE with bilateral low-density lesions in the thalamus (left image) and periventricular cerebral white matter within 30 hours after onset (right image). G) Case-patient 23, showing DCE within 7 hours after onset (left image) and a high density of frontal subcortical white matter (right image).

Main Article

1These authors contributed equally to this article.

Page created: January 22, 2026
Page updated: February 09, 2026
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