tetano
Editor, Senior Moderator
Eur J Neurol
. 2021 Jun 1.
doi: 10.1111/ene.14952. Online ahead of print.
Systematic Review of Cases of Acute Myelitis in Individuals with COVID-19
Eva C Schulte[SUP] 1 2 3 [/SUP], Larissa Hauer[SUP] 4 [/SUP], Alexander B Kunz[SUP] 5 6 [/SUP], Johann Sellner[SUP] 5 7 8 [/SUP]
Affiliations
Abstract
Background: An incremental number of cases of acute transverse myelitis (ATM) in individuals with ongoing or recent coronavirus disease 2019 (COVID-19) have been reported.
Methods: We performed a systematic review of cases of ATM described in the context of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection by screening both articles published and in preprint.
Results: Twenty cases were identified. There was a slight male predominance (60.0%) and the median age was 56 years. Neurological symptoms first manifested after a mean of 10.3 days from the first onset of classical, mostly respiratory symptoms of COVID-19. Overall, COVID-19 severity was relatively mild. PCR of CSF for SARS-CoV-2 was negative in all 14 cases examined. Cerebrospinal fluid findings reflected an inflammatory process in most instances (77.8%). Aquaporin-4 and myelin oligodendrocyte protein (tested in 10 and 9 cases, respectively) antibodies in serum were negative. On MRI, the spinal cord lesions spanned a mean of 9.8 vertebral segments, necrotic-hemorrhagic transformation was present in three cases and two individuals had additional acute motor axonal neuropathy. More than half of the patients received a second immunotherapy regimen. Over a limited follow-up period of several weeks, 90% of individuals recovered either partially or near fully.
Conclusion: Although causality cannot readily be inferred, it is possible that cases of ATM occur para- or post-infectiously in COVID-19. All identified reports are anecdotal and case descriptions are heterogenous. Whether the condition and the observed radiological characteristics are specific to SARS-CoV-2 infection needs to be clarified.
Keywords: COVID-19; SARS-CoV-2; acute transverse myelitis; autoimmune; immune-mediated; neuroinfection; neurological complication.
. 2021 Jun 1.
doi: 10.1111/ene.14952. Online ahead of print.
Systematic Review of Cases of Acute Myelitis in Individuals with COVID-19
Eva C Schulte[SUP] 1 2 3 [/SUP], Larissa Hauer[SUP] 4 [/SUP], Alexander B Kunz[SUP] 5 6 [/SUP], Johann Sellner[SUP] 5 7 8 [/SUP]
Affiliations
- PMID: 34060708
- DOI: 10.1111/ene.14952
Abstract
Background: An incremental number of cases of acute transverse myelitis (ATM) in individuals with ongoing or recent coronavirus disease 2019 (COVID-19) have been reported.
Methods: We performed a systematic review of cases of ATM described in the context of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection by screening both articles published and in preprint.
Results: Twenty cases were identified. There was a slight male predominance (60.0%) and the median age was 56 years. Neurological symptoms first manifested after a mean of 10.3 days from the first onset of classical, mostly respiratory symptoms of COVID-19. Overall, COVID-19 severity was relatively mild. PCR of CSF for SARS-CoV-2 was negative in all 14 cases examined. Cerebrospinal fluid findings reflected an inflammatory process in most instances (77.8%). Aquaporin-4 and myelin oligodendrocyte protein (tested in 10 and 9 cases, respectively) antibodies in serum were negative. On MRI, the spinal cord lesions spanned a mean of 9.8 vertebral segments, necrotic-hemorrhagic transformation was present in three cases and two individuals had additional acute motor axonal neuropathy. More than half of the patients received a second immunotherapy regimen. Over a limited follow-up period of several weeks, 90% of individuals recovered either partially or near fully.
Conclusion: Although causality cannot readily be inferred, it is possible that cases of ATM occur para- or post-infectiously in COVID-19. All identified reports are anecdotal and case descriptions are heterogenous. Whether the condition and the observed radiological characteristics are specific to SARS-CoV-2 infection needs to be clarified.
Keywords: COVID-19; SARS-CoV-2; acute transverse myelitis; autoimmune; immune-mediated; neuroinfection; neurological complication.