Development of Acute Transverse Myelitis following COVID-19 Infection: A Review on the Potential Pathways

Abstract

Background: Acute transverse myelitis (ATM) is a rare neurological disorder in adults characterized by localized inflammation of gray and white matter in one or more contiguous spinal cord segments in the absence of a compressive injury. Several reports have connected the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to the pathophysiology of ATM. Summary: Direct invasion of the spinal cord, cytokine storm, or an autoimmune response are the possible pathways by which the SARS-CoV-2 virus can affect the spinal cord and lead to ATM. Direct invasion is facilitated by the presence of angiotensin-converting enzyme 2 (ACE2) receptors on the membranes of the spinal cord neurons. Cytokine storm syndrome could be derived from elevated levels of several immunological factors following severe involvement with Coronavirus disease 2019 (COVID-19). Finally, autoimmune responses can cause post-infectious ATM through several hypothesized processes, including molecular mimicry, epitope spreading, bystander activation, and polyclonal B-cell activation. Key Messages: COVID-19-induced ATM is mostly a longitudinally-extensive ATM (LEATM) in which more spinal cord segments are damaged, which results in a worse sequel compared to short-segment ATM. Therefore, it is suggested that COVID-19 patients, particularly severe cases, be followed up for a probable incidence of ATM, even long after recovery from the disease and elimination of the virus from the host, because an early diagnosis and effective therapy may stop the spread of inflammation to adjacent segments.

Rehabilitation of Rare Neurological Complications of COVID-19 Infection in Health Resort Settings

“…The current evidence consists of a small number of case reports. Some proposed pathways by which SARS-CoV-2 could affect the spinal cord are direct invasion of the spinal cord, cytokine storm, or an autoimmune response [ 15 ]. A possible mechanism for post-infectious acute transversal myelitis is similar to GBS, molecular mimicry, where immune-mediated injury to the nervous system occurs due to the production of autoantibodies [ 16 ].…”

Functional Recovery and Regenerative Effects of Direct Transcutaneous Electrical Nerve Stimulation in Treatment of Post-COVID-19 Guillain–Barré and Acute Transverse Myelitis Overlap Syndrome: A Clinical Case

“…The complete pathophysiology of ATM is unknown, but many authors believe that the disease develops as a result of an autoimmune reaction, which may be idiopathic or associated with post-infectious or para-infectious events [ 3 ]. Recently, several clinical cases of ATM associated with post-COVID-19 infection have been reported [ 4 , 5 , 6 ] and, in extremely rare cases, in combination with another autoimmune disease—Guillain–Barré syndrome (GBS) [ 7 , 8 ]. In 40% of patients with ATM and in 30% of patients with GBS, residual motor, sensory and autonomic disorders may persist for months or even years due to resistance to pharmacotherapy [ 9 , 10 ].…”

A Case Report of Acupotomy Treatment on the Acute Myelitis Patient

“…급성 횡단성 척수염은 척수가 지배하는 해당 분절에 영향을 미치는 염증 반응이 있는 질환으로서 운동 기능, 감각 기능, 자 율 신경의 장애를 초래하는 질환이다 1,2) . 급성 횡단성 척수염은 성인에게 드물게 발생하는 신경학 적 장애로서 연간 발생률은 100만 명당 1.34-4.6명으로 추 정되며, 평균 발생 연령은 35세에서 40세이다 1) .…”

“…급성 횡단성 척수염은 척수가 지배하는 해당 분절에 영향을 미치는 염증 반응이 있는 질환으로서 운동 기능, 감각 기능, 자 율 신경의 장애를 초래하는 질환이다 1,2) . 급성 횡단성 척수염은 성인에게 드물게 발생하는 신경학 적 장애로서 연간 발생률은 100만 명당 1.34-4.6명으로 추 정되며, 평균 발생 연령은 35세에서 40세이다 1) . 급성 횡단성 척수염은 전신홍반성 루푸스(SLE), 쇼그렌 증후군(Sjögren syndrome), 베체트병(Behçet disease) 등 많은 전신 염증성 질환에 동반되어서 혹은 그로 인해 발생한 경우들이 있으나, 60%의 경우에 원인이 확실하게 규명되지 않는 상황이다 3,4) .…”