Author reply to letter to the editor "Imaging abnormalities in pediatric neuro-COVID are more diverse than specified".

This letter is in response to the letter by Dr Finsterer [1], which commented on our review of neuroimaging mimics in children with COVID-19 infection [2] and expressed that our article was interesting but incomplete and should include more neuroimaging abnormalities associated with pediatric COVID-19 infection. We appreciate their interest in this article and feel encouraged to share our common enthusiasm towards the neuroimaging manifestations in pediatric COVID-19 infection, based on the common belief that the neuroimaging abnormalities are likely to be diverse or placed on a spectrum, as our titles indicate.

This letter is in response to the letter by Dr Finsterer [1], which commented on our review of neuroimaging mimics in children with COVID-19 infection [2] and expressed that our article was interesting but incomplete and should include more neuroimaging abnormalities associated with pediatric COVID-19 infection. We appreciate their interest in this article and feel encouraged to share our common enthusiasm towards the neuroimaging manifestations in pediatric COVID-19 infection, based on the common belief that the neuroimaging abnormalities are likely to be diverse or placed on a spectrum, as our titles indicate.

In our review article, we aimed to address the neuroimaging spectrum of the majority of reported neurological diseases in children with COVID-19 infection. Specifically, ischemia was discussed under venous sinus thrombosis, and vasculitis and infarction. Inflammatory brain diseases were discussed in our article under encephalitis, acute necrotizing encephalopathy, and acute disseminated encephalomyelitis. However, because of space limitation, rarely reported neurological entities were not included in our article. As COVID-19 infection continues to spread among children globally at the time of writing this response, neurological disorders not previously reported to associate with COVID-19 infection are expected to emerge. Likewise, during the recent Omicron subtype outbreak in Taiwan that was nine months after the writing of our review article, rarely reported severe neurological conditions like acute fulminant cerebral edema and acute hemorrhagic leukoencephalitis had emerged in our institution.

We encourage and appreciate the continual enthusiastic concern on neuroimaging manifestations of children with COVID-19 infection. We hope such a concern may let us more thoroughly understand the pathophysiology and help the management of these neurological conditions.

Conflict of interest

The authors declare no conflicts of interest.