Pulmonary Embolism After Acute Spinal Cord Injury and COVID-19

Abstract

The coronavirus virus disease 2019 (COVID-19) is best known for its pulmonary sequelae. Understanding of the disease process is rapidly growing and the medical community already appreciates a hypercoagulable state associated with COVID-19. Acute spinal cord injury (SCI) has an inherent increased risk for venous thromboembolism (VTE). In this case report the patient presented with bilateral lower extremity weakness and sensory loss secondary to thoracic disc herniation. Incidentally, at the same time as the initial presentation, the patient was also found to have COVID-19 without significant respiratory symptoms. During hospitalization, the patient developed extensive bilateral lower extremity deep vein thrombosis (DVT) despite chemoprophylaxis. Therapeutic anticoagulation was initiated, yet several days later he developed pleuritic chest pain. Computed tomography (CT) angiography revealed bilateral pulmonary emboli. This case highlights the need for clinicians to have elevated vigilance in regards to screening and treatment for VTE in high-risk patients, such as SCI with a concurrent diagnosis of COVID-19.

Long-COVID and Post-COVID Health Complications: An Up-to-Date Review on Clinical Conditions and Their Possible Molecular Mechanisms

“…The cytokine storm activates defense processes, stimulating biochemical pathways and leading to the production of tissue injury markers and the collapse of lung tissue [56][57][58]. Among the main associated pathologies, we can highlight: respiratory failure [58,59], pulmonary thromboembolism [5,50,60], pulmonary embolism [61,62], pneumonia [57,63], pulmonary vascular damage [64], and postviral pulmonary fibrosis [55,65]. Pulmonary vein thrombosis is rarely found, but can present together with dyspnea, cough, chest pain, and/or hemoptysis, causing systemic arterial embolism [64].…”

Initial assessment and management of respiratory infections in persons with spinal cord injuries and disorders in the COVID‐19 era

“…The epidemiology of COVID‐19 in persons with SCI/D is incompletely understood but appears to be similar to the general population; there have been a range of presentations from mild to severe disease 7–11 . In addition to respiratory weakness, the SCI/D population has a high prevalence of hypertension, coronary artery disease, diabetes, and obesity, which are recognized to increase risk of COVID‐19 complications 12,13 .…”

“…In addition to respiratory weakness, the SCI/D population has a high prevalence of hypertension, coronary artery disease, diabetes, and obesity, which are recognized to increase risk of COVID‐19 complications 12,13 . Of 25 cases of COVID‐19 infection reported thus far, one sudden death has been described in a patient with new traumatic SCI/D and mild COVID‐19, 5 cases were described as severe with Modified Early Warning Scale (MEWS) score ≥3 and <5, and the remainder were non‐severe 7–11 . Recovery courses have ranged from 10 days to a few months, with older patients with high tetraplegia, tracheostomy, and severe COVID‐19 courses having the slowest recovery.…”

“…Much of the published information on COVID‐19 presentation in persons with SCI/D comes from European SCI specialty and rehabilitation centers. Common presenting symptoms include prolonged fever with varying severity that does not improve with antibiotics, dry cough, fatigue/weakness, dyspnea, increased expectoration, diarrhea, and anosmia 7‐11,29 . An international survey of 783 SCI/D clinicians reported the most common presenting symptom of COVID‐19 in patients with SCI/D was fever (86.2%), followed by shortness of breath (62.1%), body aches/worsening pain (20.7%), sweats (20.7%), and chest pain (13.8%).…”

“…One asymptomatic individual with new paraplegia, incidentally diagnosed with COVID‐19, developed extensive bilateral lower extremity venous thromboembolism while on chemoprophylaxis and, later, pleuritic chest pain due to pulmonary embolism developed while receiving therapeutic anticoagulation 11 …”