Transverse myelitis following COVID-19: Insights from a multi-center study and systematic literature review

Adamec, Ivan; Jakob, Gregor Brecl; Drulović, Jelena; Sellner, Johann; Bilić, Ervina; Sitaš, Barbara; Bilić, Hrvoje; Tamaš, Olivera; Budimkić, Maja; Veselinović, N.; Ledinek, Alenka Horvat; Jerše, Jana; Gomezelj, Sarah; Hauer, Larissa; Skorić, Magdalena Krbot; Habek, Mario

doi:10.1016/j.jns.2022.120463

Cited by 3 publications

(14 citation statements)

References 61 publications

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“…Besides myocarditis/pericarditis due to SARS-CoV-2 infection/COVID-19 and COVID-19 vaccination, other severe health conditions were observed, including neurological ones and issues by the reactivation of chronic infections. For example, transverse myelitis has been documented due to COVID-19 [180] , [181] , [182] , [183] , [184] , [185] , [186] and COVID-19 vaccination [187] , [188] , [189] , [190] , [191] , [192] , [193] , [194] . In addition, VZV and herpes simplex virus, cytomegalovirus and Epstein-Barr virus reactivation was found to be possibly occurring due to COVID-19 [11] , [12] , [195] , [196] , [197] , [198] , [199] , [200] , [201] , [202] , [203] , [204] and COVID-19 vaccination [205] , [206] , [207] , [208] , [209] , [210] , [211] , [212] , [213] .…”

Section: Sars-cov-2 Infection- and Covid-19 Vaccination-induced Syndr...mentioning

confidence: 99%

COVID-19, post-acute COVID-19 syndrome (PACS, “long COVID”) and post-COVID-19 vaccination syndrome (PCVS, “post-COVIDvac-syndrome”): Similarities and differences

Scholkmann

May

2023

Pathology - Research and Practice

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Section: Sars-cov-2 Infection- and Covid-19 Vaccination-induced Syndr...mentioning

confidence: 99%

COVID-19, post-acute COVID-19 syndrome (PACS, “long COVID”) and post-COVID-19 vaccination syndrome (PCVS, “post-COVIDvac-syndrome”): Similarities and differences

Scholkmann

May

2023

Pathology - Research and Practice

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“…The neurological manifestations include headache and dizziness, myalgia and fatigue, stroke, encephalitis and myelitis, encephalopathy syndrome, and peripheral neuropathy. And myelitis post-SARS-CoV-2 infection accounts for 1.2% of the neurological associations [ 6 , 15 ]. TM is defined as acute or subacute spinal cord dysfunction with motor, sensory, and autonomic dysfunction below the lesion level [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…T2 hyperintensities were described as “patchy lesions” in three cases and “patchy enhancement” in two cases. Adamec et al [ 6 ] reported discontinued T2 hyperintense lesions in 7/13 patients. Memon et al [ 7 ] described multifocal T2 signal abnormality on sagittal STIR, which was mostly distributed in the lateral funiculus on axial T2 of the repeated MRI.…”

Section: Discussionmentioning

confidence: 99%

“…This might explain the lack of apparent spinal cord MRI findings. Some studies suggested that a normal MRI of the spinal cord may be a sign of poor prognosis [ 6 , 9 ]. The four patients in this study did not benefit from pulse therapy of methylprednisolone and PLEX.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of myelitis post COVID-19 infection was 0.5 per million based on the 1760 COVID-19 series from Italy [ 3 ], which may account for 1.2% of all neurological complications of COVID-19 [ 4 , 5 ]. Notably, the clinical manifestations, evolution, and spinal cord magnetic resonance imaging (MRI) features of COVID-19-associated myelitis may differ significantly from those of traditional TM [ 6 ]. Some patients may present delayed onset for 3 months after infection [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Atypical and delayed spinal cord MRI features of COVID-19-associated myelopathies: a report of four cases and literature review

Wang,

Zhang,

Lin

et al. 2024

Neurol Sci

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We reported four patients with coronavirus disease 2019 (COVID-19)–associated myelopathies, highlighting the delayed and atypical spinal cord magnetic resonance imaging (MRI) features and the literature review. All four patients were males, aged 37 to 72 years old. The latencies from COVID-19 to the onset of myelitis were 5, 15, 30, and 80 days. The initial symptoms were numbness and weakness of lower limbs in three cases, and back pain with weakness of lower limbs in one case. The peak symptoms included paraplegia, sphincter dysfunction, sensory disturbance level, and spastic gait. The EDSS scores were 7.5, 9.0, 9.0, and 7.5, respectively. Magnetic resonance imaging (MRI) showed delayed atypical spinal cord lesions at onset, i.e., two cases without lesions, one with linear spinal meningeal enhancement, and one with punctate lesions on T2-weighted imaging (T2WI). During the follow-up period, punctate, linear, and cloudy lesions in the lateral and posterior funiculus were seen on T2WI in the peak stage. The prominent features of spinal cord lesions were linear spinal meningeal enhancement, the mismatch of deteriorated clinical symptoms, and inapparent MRI findings. All four patients were left with an obvious disability, with two patients completely bedridden and two who could stand with support. This report highlights the recognition of COVID-19-associated myelopathy even months after initial infection, especially in patients with delayed and atypical spinal cord findings on MRI.

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COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 Detection

Gomes,

Lima,

Valente

et al. 2024

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There have been multiple reports of COVID-19 associated neurological symp-toms, including several cases of para-infectious myelitis.We report a case of an 84-year-old male patient presenting with acute paraparesis coinciding with active mild COVID-19 pneumonia. Spinal cord magnetic resonance imaging (MRI) showed longitudinally extensive transverse myelitis (LETM) affecting the entire cervical cord to the tenth thoracic level, and cerebral spinal fluid (CSF) was positive for SARS-CoV-2. The patient was evaluated for other causes of LETM, which were convincingly excluded. He was treated with steroid pulses and plasmapheresis, with significant imaging improvement. The patient has since made a good recovery, being now able to walk unassisted. Although several instances of COVID-19 associated myelitis have been reported, positive identification of the virus in CSF is rare. The identification of viral material may support the hypothesis of direct spinal cord infection in co-occurrence with a para-infectious inflammatory reaction.

show abstract

Transverse myelitis following COVID-19: Insights from a multi-center study and systematic literature review

Cited by 3 publications

References 61 publications

COVID-19, post-acute COVID-19 syndrome (PACS, “long COVID”) and post-COVID-19 vaccination syndrome (PCVS, “post-COVIDvac-syndrome”): Similarities and differences

COVID-19, post-acute COVID-19 syndrome (PACS, “long COVID”) and post-COVID-19 vaccination syndrome (PCVS, “post-COVIDvac-syndrome”): Similarities and differences

Atypical and delayed spinal cord MRI features of COVID-19-associated myelopathies: a report of four cases and literature review

COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 Detection

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