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We report a case of transverse myelitis and Guillain–Barre syndrome (GBS) overlap in the 42-year-old patient with moderate course of Coronavirus disease 2019 (СOVID-19). Nasopharyngeal SARS-CoV 2 RT-PCR was positive. Severe neck pain developed in this patient on the 5-th day of СOVID-19. A few hours later weakness in the feet arised and then spread to the thighs and arms. Quadriparesis, arefl exia in all limbs, sensory loss below the level of T4 and bladder/bowel dysfunction were present. Pyramidal signs were negative. There was no increase of COVID-19 severity at the time of neurological signs development. Magnetic resonance imaging of the spinal cord showed the focal lesion in the C2-T1 segments, which was consistent with the features of longitudinally extensive transverse myelitis. Along with the myelitis, acute motor axonal polyneuropathy was diagnosed. This diagnosis of GBS was supported by ascending weakness with arefl exia, albumin-cytological dissociation in cerebrospinal fl uid and the data of neuroelectrophysiological examination. We proposed that both myelitis and GBS had disimmune nature associated with COVID-19. The other possible causes of damage to the spinal cord and peripheral nervous system were excluded.Immunotherapy with high dose of intravenous immunoglobulins was administered. Steroids also were used taking into account the myelitis. At the follow up in 4 months the motor functions were found to be improved nonsignifi cantly, the patient was still severe disabled.

A review of Russian and foreign medical literature, as well as the Web of Science, PubMed and Scopus databases, revealed 8 cases of multiple sclerosis and Parkinson's disease co-occurrence. Parkinson's disease is a chronic, progressive neurological disease caused by degeneration of dopaminergic neurons in the substantia nigra. Multiple sclerosis is a chronic demyelinating disease, in which a range of autoimmune-driven inflammatory and neurodegenerative processes lead to formation of numerous focal and diffuse lesions in the central nervous system, resulting in disability and a significant decrease in patient quality of life. The co-occurrence of these two neurodegenerative CNS disorders is rarely seen in clinical practice. The authors describe a clinical case to demonstrate their approach to the diagnosis and management of this patient group.

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