Background Transverse myelitis (TM) is a relatively uncommon condition, and vaccine-associated myelitis is even rarer. Concern regarding neurological complications following vaccination escalated following the report of TM during the safety and efficacy trials of the COVID-19 vaccine. Case presentation We report the first case of Longitudinal Extensive Transverse Myelitis (LETM) in Malaysia following administration of the chimpanzee adenovirus-vectored (ChAdOx1 nCoV-19) vaccine. A 25-year-old female presented with bilateral lower limb weakness and inability to walk with a sensory level up to T8 with absent visual symptoms. Urgent gadolinium-enhanced magnetic resonance imaging (MRI) of the spine showed long segment TM over the thoracic region. Cerebrospinal fluid autoantibodies for anti-aquaporin-4 and anti-myelin-oligodendrocyte were negative. A diagnosis of LETM following vaccination was made, and the patient was started on a high dose of intravenous methylprednisolone. The patient eventually made a recovery following treatment. Conclusion LETM is a rare but serious adverse reaction following vaccination. Previously reported cases showed an onset of symptoms between 10 to 14 days post-vaccination, suggesting a delayed immunogenic reaction. However, the incidence of myelitis in COVID-19 is much more common, far greater than the risk associated with vaccination.

Putra Acute Stroke protocol

COVID-19 associated neurological syndromes, including acute ischemic stroke, pose a challenge to treating physicians. The role of MRI in aiding diagnosis and further management is indispensable. The advent of new MRI sequences such as vessel wall imaging (VWI) allows an avenue in which these patients could be better investigated and treated. We describe our experience in managing a patient with COVID-19 associated atherothrombosis and stroke, focusing on the VWI imaging findings.

Objective: Our aim is to determine the average intraoperative blood loss in patients who underwent pre-operative spinal tumour embolisation in PPUKM from 2010 until 2016 and to compare with other centres from literature review. Material And Methodology: 15 patients in PPUKM with spinal tumour and spinal metastatic disease underwent pre-operative embolisation before palliative spinal surgery between 2010 and 2016 in PPUKM. Intraoperative blood loss during palliative spinal surgery was documented obtaining the average and median blood loss. Secondary analyses were made on the amount of intraoperative blood loss in comparison to the embolisation materials, degree of embolisation completion, primary malignancy, level of spinal metastatic involvement and total operating time. Result: The average and median intraoperative blood loss during palliative spinal surgery were 1480mls and 1000mls respectively, which is comparable with other centre from literature review. Significant difference is noted in intraoperative blood loss between the different embolisation materials used (P<0.01). 10 patients had complete embolisation and 4 patients had incomplete embolisation with significant difference in terms of blood loss between these 2 groups with P value of <0.01. There was significant positive correlation between operating time and intra-operative blood loss, whereby the longer the operation, the higher the amount of blood loss. Conclusion: The average intraoperative blood loss in patients with pre-operative spinal tumour embolisation in PPUKM is comparable to other centres from literature review thus pre-operative tumour embolisation can reduce perioperative haemorrhage. However, larger study is needed to further analyse correlation between these factors in affecting intraoperative blood loss.

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