Immunocompromised status keeps on being a challenge for a neurologist, especially in the context of the coronavirus disease – 19 (COVID-19) pandemic. We report a clinical case of a human-immunodeficiency virus (HIV) - positive patient who developed an acute transverse myelitis. Magnetic Resonance Imaging (MRI) examination showed longitudinally extensive spinal cord abnormality, and laboratory tests confirmed SARS-CoV-2 infection. The patient responded to methylprednisolone pulse therapy and therapeutic plasma exchange. No cases of HIV-positive patients with myelitis and COVID-19 has been reported yet.

Background: Ischemic stroke is one of the leading causes of mortality and disability worldwide. Numerous studies were performed to assess the risk of clinical deterioration of acute ischemic stroke patients, including the risk of haemorrhagic transformation. The complexity of cerebral ischemia pathology raised the possibility of a multitude of candidate-molecules to be studied as stroke biomarkers. The blood brain barrier integrity biomarkers have shown promising results both in fundamental and clinical studies. Matrix metalloproteinases have been extensively analysed and gave encouraging results for predicting unfavourable neurological outcome, including the risk for haemorrhagic transformation. Matrix metalloproteinase-9 plays a crucial role in the disruption of the blood-brain barrier following focal cerebral ischemic stroke. Elevated matrix metalloproteinase-2 levels are responsible for the degradation of tight junction proteins, basal lamina and neuronal injury after ischemia, and may contribute to infarction and hemorrhagic volume. The review provides an overview of matrix metalloproteinases’ role in the prognosis of acute ischemic stroke patients, regarding the stroke outcome and the risk of haemorrhagic transformation. Conclusions: Matrix metalloproteinases, especially gelatinases, are extensively studied for their predictive value in ischemic stroke evolution. Matrix metalloproteinase-2 and matrix metalloproteinase-9 correlate with stroke severity and haemorrhagic transformation in acute ischemic stroke, but large validation studies are needed for practical translation. Future studies should focus on developing a biomarker panel for predicting outcomes in stroke patients.

Transverse myelitis (TM) is a clinical syndrome in which an inflammatory process causes neuronal damage to the spinal cord, leading to varying degrees of muscle weakness, sensory changes, and autonomic dysfunction. MT can be a form of presentation of a multi-focal CNS disease, multi-systemic, infectious, paraneoplastic, demyelinating, autoimmune or idiopathic disease.The purpose of the research was to analyze the cases of transverse myelitis codes in patients treated and hospitalized in the “Diomid Gherman” Institute of Neurology and Neurosurgery.Material and method: 22905 medical records of patients treated in the Institute of Neurology and Neurosurgery between February 2018 and April 2022 were analyzed, 53 patients diagnosed with transverse myelitis were selected and 44 records were eligible, analyzed and included in the study. Results: The average age of the subjects included in the research was 50.9±11.7 years, they were on treatment for an average of 11.2±8.04 days. Neurological manifestations were presented in 43 people. The clinical presentation included: sensitivity disorders (75%), sphincteric disorders (61.4%), limb paresthesia (40.9%), motility disorders (95.5%), fever (4.5%), depression (6.8%), headache (15.9%), back pain (15.9%). The most frequent investigations performed on patients in the study group was CT/MRI thoracic, cervical, lumbo-sacral, cerebral, EMG. Lumbar puncture was performed in 32 patients (72.7%) with CSF examination. Laboratory analyzes showed signs of inflammation - 54.5%, elevated blood sugar - 40.8%, dyslipidemia - 38.6% and anemia - 25%. Corticosteroid treatment was performed in 25 subjects (56.8%) with improvement in most cases (80%). Frequent complications were urinary infection (52.3%), pneumonia (9.1%), 2 deaths (4.5%). Conclusion: The analysis of the institutional cohort of patients with transverse myelitis confirmed that the diagnosis of MT continues to present a challenge and requires a complex approach, correct both clinical and paraclinical.

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