MRI-negative myeloradiculoneuropathy following Covid-19 infection: An index case

Abstract

Covid-19 associated several neurological manifestation in the form of Post-infectious transverse myelitis(TM) and para-infectious TM has been reported. A 54 years old female patient presented to us with acute retention of urine and upper motor neuron type of bilateral lower limb weakness in shock stage, after 12 days of covid-19 infection. MRI (3T) brain and spine showed no abnormality and Nerve conduction study showed acquired motor axonal polyradiculoneuropathy in bilateral lower limbs. We herein present an index case of MRI-negative myeloradiculoneuropathy following covid-19 infection.

Magnetic Resonance Imaging-negative Acute Inflammatory Myelopathy following Severe Acute Respiratory Syndrome Coronavirus 2 Infection

“…Patients with MRI-positive COVID-19-associated myelopathy typically have LETM ( 11 , 12 , 14 , 15 ); however, a small number of cases with suspected myelopathy show no abnormal findings on MRI of the spine ( 16 - 20 ), as in our patient. To our knowledge, there have been nine reported cases of MRI-negative COVID-19-associated myelopathy, including our patient ( 16 - 20 ), as summarized in Table 2 . Concomitant brain lesions were not observed in these patients.…”

MRI-negative myelitis associated with cerebral venous thrombosis after COVID-19 infection

“…Therefore, the early initiation of therapy may be a contributing factor. However, Metya et al 15 described only mild improvement of the already severe symptoms at presentation. So, the severity of symptoms may be another factor that can determine the degree of improvement after treatment.…”

“…Several cases of MRI-negative myelitis after COVID-19 were described in the literature, with some of them being associated with radiculopathy. 15 Table 2 shows all the nine documented cases of MRI-negative myelitis in association with COVID-19, five of them were reported in the series of Abrams et al . 4 Notably, all cases showed partial or no improvement after management, whereas our patient demonstrated an almost complete resolution of symptoms.…”

“…Several cases of MRI-negative myelitis after COVID-19 were described in the literature, with some of them being associated with radiculopathy 15 Table 2. shows all the nine documented cases of MRI-negative myelitis in association with COVID-19, five of them were reported in the series of Abrams et al 4.…”

The clinical neurophysiology of COVID-19-direct infection, long-term sequelae and para-immunization responses: A literature review

“…It is noteworthy that none of these patients manifested brainstem auditory evoked potential abnormalities, which provides electrophysiological evidence against widespread central nervous system (CNS) demyelination. Moreover, CNS demyelination associated with COVID-19 may manifest unremarkable VEPs ( Metya et al, 2021 ). Although there has been some pathological evidence of SARS-CoV-2 virus neurotropism, it is unclear if the clinical manifestations are due to an autoimmune response to the virus or a direct result of neuroinvasion ( Costello and Dalakas, 2020 ).…”