Retrospective data were collected from May 2021 to September 2021, including all children aged from 1month to 18 years of age who presented to our pediatric emergency or OPD (a tertiary care center from western Rajasthan, India) with the neurological manifestation with history of COVID-19 infection or exposure and positive SARS-CoV-2 serology. Those who are RT PCR positive were excluded. The neurological manifestations were further categorized in a pre-designed proforma. 

Case records of the 18 children who fulfilled the criteria were included in the study, among them 7 (38.8%) were male and 11 (61.1%) were female. Predominant presentation in our study group was seizures (6/18) and Gullian Barre Syndrome (5/18). Other manifestations included stroke (2/18), ADEM (1/18), MS (1/18), LETM (1/18), Autoimmune encephalitis[NMDAR](2/18). 

In our study group, 13/18 (72.2%) required immunomodulatory therapy either IVIG or high dose methylprednisolone pulse therapy. Steroids were used upfront in patients with elevated inflammatory markers. Cerebrovascular complications in children were less common compared to adults. Most of the children had favourable outcomes except for one mortality in our cohort. 

Delayed complications following SARS-CoV2 infection with varied manifestations are seen in children. A temporal correlation between the COVID 19 infection and the increasing number of neurological cases after the second wave was noted. Steroids are beneficial while treating such patients. Testing for SARS-CoV2 serology during the pandemic can give a clue to the underlying etiology. However, further studies are required to understand the CNS effects of SARS-CoV2 infection in children.