Transverse myelitis&amp;nbsp;in COVID-19 patients: Report of two cases

Advani, Soroor; Zali, Alireza; Ommi, Davood; Fatemi, Alireza; Khoshnoud, Reza Jalili; Ashrafi, Farzad

doi:10.21203/rs.3.rs-107744/v1

Cited by 6 publications

(36 citation statements)

References 13 publications

(13 reference statements)

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“…Eight patients (30.8%) 11 – 13 , 17 , 19 – 21 , 25 presented demyelinating changes in “thoracic region only.” Demyelinating change in “cervical region only” was seen in six patients (23.1%). 18 , 26 – 28 , 30 , 31 Another 12 patients (46.1%) 14 – 16 , 22 – 26 , 29 , 38 , 40 , 41 showed demyelinating changes in both the cervical and thoracic regions.…”

Section: Resultsmentioning

confidence: 99%

“…The latency period (mean time between the onset of COVID-19 infection to first symptom of inflammatory myelopathy) of AIM varied from 2 days 22 to 3 wks. 31 , 33 Six patients 16 , 21 , 26 , 28 , 29 , 34 did not report any COVID-19 symptoms previously, presented directly with neurological symptoms (either urinary symptoms or sudden weakness).…”

Section: Resultsmentioning

confidence: 99%

“… 11 – 13 , 15 – 20 , 22 – 30 , 38 , 40 , 41 One had hemiplegia, 28 and 22 had motor deficits in both lower limbs (symmetrical involvement). The evolution of paralysis varied from patient to patient, from abrupt onset (few hours) 25 , 26 , 28 to 7 days. 18 …”

Section: Resultsmentioning

confidence: 99%

“… 24 , 26 , 38 Oligoclonal bands (OCBs) were identified in three patients. 24 , 26 , 33 Two patients were SARS-CoV-2 RT-PCR positive. 16 , 31 …”

Section: Resultsmentioning

confidence: 99%

“…The exact mechanism of spinal cord involvement after COVID-19 infection has not yet been determined. However, it has been suggested that SARS-CoV-2 can damage the spinal cord through the angiotensin-converting enzyme (ACE) 2 receptors present in the cell surface 23 , 26 , 29 or through the mechanism of cytokine storm or post–infectious inflammatory or immune-mediated mechanism. 13 , 23 , 29 , 42 , 43 …”

Section: Discussionmentioning

confidence: 99%

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Clinical Features, Laboratory, and Radiological Findings of Patients With Acute Inflammatory Myelopathy After COVID-19 Infection

Barman

Sahoo

Viswanath

et al. 2021

Am J Phys Med Rehabil

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The objective of this review was to analyze the existing data on acute inflammatory myelopathies associated with coronavirus disease 2019 infection, which were reported globally in 2020. PubMed, CENTRAL, MEDLINE, and online publication databases were searched. Thirty-three acute inflammatory myelopathy cases (among them, seven cases had associated brain lesions) associated with coronavirus disease 2019 infection were reported. Demyelinating change was seen in cervical and thoracic regions (27.3% each, separately). Simultaneous involvement of both regions, cervical and thoracic, was seen in 45.4% of the patients. Most acute inflammatory myelopathy disorders reported sensory motor and bowel bladder dysfunctions. On cerebrospinal fluid analysis, pleocytosis and increased protein were reported in 56.7% and 76.7% of the patients, respectively. Cerebrospinal fluid severe acute respiratory syndrome coronavirus 2 reverse transcriptase–polymerase chain reaction was positive in five patients. On T2-weighted imaging, longitudinally extensive transverse myelitis and short-segment demyelinating lesions were reported in 76% and 21%, respectively. Among the patients with longitudinally extensive transverse myelitis, 61% reported “moderate to significant” improvement and 26% demonstrated “no improvement” in the motor function of lower limbs. Demyelinating changes in the entire spinal cord were observed in three patients. Most of the patients with acute inflammatory myelopathy (including brain lesions) were treated with methylprednisolone (81.8%) and plasma-exchange therapy (42.4%). An early treatment, especially with intravenous methylprednisolone with or without immunoglobulin and plasma-exchange therapy, helped improve motor recovery in the patients with acute inflammatory myelopathy associated with coronavirus disease 2019.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“… 24 , 26 , 38 Oligoclonal bands (OCBs) were identified in three patients. 24 , 26 , 33 Two patients were SARS-CoV-2 RT-PCR positive. 16 , 31 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Features, Laboratory, and Radiological Findings of Patients With Acute Inflammatory Myelopathy After COVID-19 Infection

Barman

Sahoo

Viswanath

et al. 2021

Am J Phys Med Rehabil

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Neurological complications of COVID-19

Cao

Jiang

et al. 2022

QJM: An International Journal of Medicine

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COVID-19 has caused several pandemic peaks worldwide due to its high variability and infectiousness, and COVID-19 has become a long-standing global public health problem. There is growing evidence that SARS-CoV-2 frequently causes multi-organ injuries and more severe neurological manifestations. Therefore, increased awareness of possible neurological complications is beneficial in preventing and mitigating the impact of long-term sequelae and improving the prognostic outcome of critically ill patients with COVID-19. Here, we review the main pathways of SARS-CoV-2 neuroinvasion and the potential mechanisms causing neurological damage. We also discuss in detail neurological complications, aiming to provide cutting-edge basis for subsequent related basic research and clinical studies of diagnosis and treatment.

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Acute Ascending Necrotizing Myelitis After COVID-19 Infection: A Clinicopathologic Report

et al. 2022

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Abstract:Background and Objectives:Neurological manifestations of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2, COVID-19) infection are common and varied. The objective of this report is to describe clinicopathological findings of rare acute ascending necrotizing myelitis (ANM) and briefly summarize similar COVID-19-associated longitudinally extended transverse myelitis (LETM) cases.Methods:We describe the clinical presentation, disease course, diagnostic workup, therapeutic measures, and pathological findings of ANM associated with COVID-19 infection.Results:A 31-year-old previously healthy woman developed a longitudinally extensive lower thoracic myelopathy three weeks after COVID-19 infection. The thoracic spinal cord lesion extended to cervical level in one week and then to the lower medullary level in two more weeks. Thoracic laminectomy at T5 – T6 level and cord biopsy revealed necrobiotic changes without viral particles or microglial nodules. The clinical deficit stabilized following immunomodulatory and eculizumab therapy.Conclusion:COVID-19 infection can cause ascending necrotizing myelitis. It adds to the spectrum of reported cases of COVID-19-associated encephalitis and myelitis.

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Transverse myelitis in COVID-19 patients: Report of two cases

Cited by 6 publications

References 13 publications

Clinical Features, Laboratory, and Radiological Findings of Patients With Acute Inflammatory Myelopathy After COVID-19 Infection

Clinical Features, Laboratory, and Radiological Findings of Patients With Acute Inflammatory Myelopathy After COVID-19 Infection

Neurological complications of COVID-19

Acute Ascending Necrotizing Myelitis After COVID-19 Infection: A Clinicopathologic Report

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