Myelitis Following COVID-19 Illness

Abstract

COVID-19 occurs due to infection by the SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2), which has caused havoc globally. It presents with a wide range of symptoms, mainly respiratory symptoms, but with time various neurological manifestations of the disease have also been noted, like myelitis. This case report aims to shed light on COVID-19-associated myelitis so that potential neurological complications of COVID-19 can be identified and treated timely. We report a case of a 41-year-old male who presented with weakness of all limbs with urinary complaints. He also had a cough and sore throat for the past few days. The MRI scan of the spine showed long segment myelitis in the cervical cord extending from the cervicomedullary junction to the upper end of the C4 vertebral body. COVID-19 myelitis is a rare but severe complication of COVID-19 infection and needs to be discussed.

Review of Neurological Manifestations of SARS-CoV-2

“…Other forms of stroke related to SARS-CoV-2 include cerebral venous thrombosis (CVT), branch vessel stroke, lacunar stroke, cryptogenic, free-floating thrombus, and watershed zone strokes. An intracerebral haemorrhage is a complication of long-term hospitalization or a long course of the disease, with a rate of 0.46% in 67,155 COVID-19 patients, and it is exacerbated by non-judicious anticoagulant use [ 30 - 50 ]. COVID-19 meningoencephalitis is characterized by punctate or diffuse T2 and FLAIR hyperintensities in the subcortical white matter, brainstem, temporal lobe, thalami, and claustrum.…”

“…Facial diplegia, lateral geniculate body syndrome, Landry-GBS (LGBS), polyneuritis cranialis with ataxia, brainstem encephalitis, brainstem stroke, and brainstem (or spinal cord) myelitis are all described in association with SARS-CoV-2. In addition, GBS in COVID-19 often manifests during the first two weeks of the illness, suggesting that there may be an overlap between active SARS-CoV-2 infection and the development of GBS, which supports a more para-infectious than postinfectious pathogenesis [ 35 - 40 , 50 - 55 ].…”

Mechanisms, Effects, and Management of Neurological Complications of Post-Acute Sequelae of COVID-19 (NC-PASC)

“…The acute symptomotology of COVID-19, while not a focus of this review, warrants discussion as it can pertain to NC-PASC development. During an active infection, COVID-19 can cause encephalitis [18,19], meningitis [20,21], myelitis [22], demyelination [23], and seizures [24]. However, there is limited evidence that these acute entities predict longhaul symptoms as many people report neurological symptoms following mild COVID-19.…”

Functional Recovery and Regenerative Effects of Direct Transcutaneous Electrical Nerve Stimulation in Treatment of Post-COVID-19 Guillain–Barré and Acute Transverse Myelitis Overlap Syndrome: A Clinical Case

“…The complete pathophysiology of ATM is unknown, but many authors believe that the disease develops as a result of an autoimmune reaction, which may be idiopathic or associated with post-infectious or para-infectious events [ 3 ]. Recently, several clinical cases of ATM associated with post-COVID-19 infection have been reported [ 4 , 5 , 6 ] and, in extremely rare cases, in combination with another autoimmune disease—Guillain–Barré syndrome (GBS) [ 7 , 8 ]. In 40% of patients with ATM and in 30% of patients with GBS, residual motor, sensory and autonomic disorders may persist for months or even years due to resistance to pharmacotherapy [ 9 , 10 ].…”