tetano
Editor, Senior Moderator
Intern Med
. 2025 Aug 28.
doi: 10.2169/internalmedicine.5986-25. Online ahead of print. Post-acute Corticospinal and Spinal Tractopathy after Coronavirus Disease 2019: A Novel Post-infectious Neurological Syndrome?
Nobuhiko Ohashi[SUP] 1 [/SUP], Naoya Miyahara[SUP] 2 [/SUP], Ko-Ichi Tazawa[SUP] 3 [/SUP], Ken Takasone[SUP] 1 [/SUP], Yumi Hoshino[SUP] 4 [/SUP], Yasufumi Kondo[SUP] 5 [/SUP], Akira Matsushima[SUP] 1 [/SUP], Kanji Yamamoto[SUP] 5 [/SUP], Yoshiki Sekijima[SUP] 1 [/SUP]
Affiliations
We herein report two cases of tractopathy affecting the bilateral corticospinal tracts (CSTs) and the spinal cord following coronavirus disease 2019. Both patients developed progressive sensorimotor deficits with spasticity, a truncal sensory level with severely impaired deep sensation, and bowel/bladder dysfunction one to three months post-infection. Magnetic resonance imaging (MRI) revealed bilateral CST and lateral column lesions. Somatosensory evoked potentials confirmed posterior column dysfunction. Initial treatment with intravenous methylprednisolone and immunoglobulin was ineffective; however, multiple courses of immunotherapy and prolonged corticosteroids led to marked improvement. These cases suggest a tract-specific, delayed, immune-mediated process triggered by severe acute respiratory syndrome coronavirus 2, underscoring the need for extended immunotherapy for optimal recovery.
Keywords: COVID-19; corticospinal tract; immunotherapy; tractopathy.
. 2025 Aug 28.
doi: 10.2169/internalmedicine.5986-25. Online ahead of print. Post-acute Corticospinal and Spinal Tractopathy after Coronavirus Disease 2019: A Novel Post-infectious Neurological Syndrome?
Nobuhiko Ohashi[SUP] 1 [/SUP], Naoya Miyahara[SUP] 2 [/SUP], Ko-Ichi Tazawa[SUP] 3 [/SUP], Ken Takasone[SUP] 1 [/SUP], Yumi Hoshino[SUP] 4 [/SUP], Yasufumi Kondo[SUP] 5 [/SUP], Akira Matsushima[SUP] 1 [/SUP], Kanji Yamamoto[SUP] 5 [/SUP], Yoshiki Sekijima[SUP] 1 [/SUP]
Affiliations
- PMID: 40866265
- DOI: 10.2169/internalmedicine.5986-25
We herein report two cases of tractopathy affecting the bilateral corticospinal tracts (CSTs) and the spinal cord following coronavirus disease 2019. Both patients developed progressive sensorimotor deficits with spasticity, a truncal sensory level with severely impaired deep sensation, and bowel/bladder dysfunction one to three months post-infection. Magnetic resonance imaging (MRI) revealed bilateral CST and lateral column lesions. Somatosensory evoked potentials confirmed posterior column dysfunction. Initial treatment with intravenous methylprednisolone and immunoglobulin was ineffective; however, multiple courses of immunotherapy and prolonged corticosteroids led to marked improvement. These cases suggest a tract-specific, delayed, immune-mediated process triggered by severe acute respiratory syndrome coronavirus 2, underscoring the need for extended immunotherapy for optimal recovery.
Keywords: COVID-19; corticospinal tract; immunotherapy; tractopathy.