Spastic Paraparesis After SARS-CoV-2 Infection Without Radiological Changes

Zukić, Sanela; Topcic, Ena; Hodžić, Renata; Sinanović, Osman; Vidović, Mirjana

doi:10.7759/cureus.23054

Cited by 3 publications

(2 citation statements)

References 14 publications

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“…On the other hand, 15 cases of MRI-negative myelitis/myelopathy associated with COVID-19, including the present cases, have previously been reported (Table 1) (7)(8)(9)(10)(11)(12)(13)(14)(15) The latency period from the onset of SARS-CoV-2 infection to the first neurological manifestations was three weeks or less in nine patients (mean: 12.7 days) and two months or more in five patients (mean: three months). Ten patients presented with neurological symptoms with subacute onset, and five patients presented with symptoms with acute onset.…”

Section: Discussionmentioning

confidence: 53%

Case report: MRI-negative myelitis following COVID-19 with SEP abnormalities: a case series and literature review

Kawama,

Shimazaki,

Sunami

et al. 2023

Front. Neurol.

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Coronavirus Disease 2019 (COVID-19) is known to have various, neurological manifestations. We herein report three patients with MRI-negative myelitis following COVID-19 with abnormal somatosensory evoked potentials (SEPs). Decreased amplitude of the cortical potential and prolonged latency in the SEPs contributed to diagnosing myelitis in the present patients. The SEP findings improved as the neurological symptoms improved. Despite a delay in initiating immunosuppressive treatment after myelitis onset, all the patients improved clinically. In the light of recent progress in COVID-19 research, several hypotheses can be made to explain the pathophysiology underlying MRI-negative myelitis, including antibody-binding and microglial synapse elimination.

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Section: Discussionmentioning

confidence: 53%

Case report: MRI-negative myelitis following COVID-19 with SEP abnormalities: a case series and literature review

Kawama,

Shimazaki,

Sunami

et al. 2023

Front. Neurol.

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“…Some patients may present delayed onset for 3 months after infection [7]. Some presented typical TM of paraplegia and sphincter dysfunction with normal spinal cord MRI [8][9][10], which caused diagnosis confusion and potential treatment delay [7]. These findings suggested that normal spinal cord MRI presentation may be a predictor of poor prognosis [6,9].…”

Section: Introductionmentioning

confidence: 99%

Atypical and delayed spinal cord MRI features of COVID-19-associated myelopathies: a report of four cases and literature review

Wang,

Zhang,

Lin

et al. 2024

Neurol Sci

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We reported four patients with coronavirus disease 2019 (COVID-19)–associated myelopathies, highlighting the delayed and atypical spinal cord magnetic resonance imaging (MRI) features and the literature review. All four patients were males, aged 37 to 72 years old. The latencies from COVID-19 to the onset of myelitis were 5, 15, 30, and 80 days. The initial symptoms were numbness and weakness of lower limbs in three cases, and back pain with weakness of lower limbs in one case. The peak symptoms included paraplegia, sphincter dysfunction, sensory disturbance level, and spastic gait. The EDSS scores were 7.5, 9.0, 9.0, and 7.5, respectively. Magnetic resonance imaging (MRI) showed delayed atypical spinal cord lesions at onset, i.e., two cases without lesions, one with linear spinal meningeal enhancement, and one with punctate lesions on T2-weighted imaging (T2WI). During the follow-up period, punctate, linear, and cloudy lesions in the lateral and posterior funiculus were seen on T2WI in the peak stage. The prominent features of spinal cord lesions were linear spinal meningeal enhancement, the mismatch of deteriorated clinical symptoms, and inapparent MRI findings. All four patients were left with an obvious disability, with two patients completely bedridden and two who could stand with support. This report highlights the recognition of COVID-19-associated myelopathy even months after initial infection, especially in patients with delayed and atypical spinal cord findings on MRI.

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Post-SARS-CoV-2 infection and post-vaccine-related neurological complications share clinical features and the same positivity to anti-ACE2 antibodies

Bellucci,

Bozzano,

Castellano

et al. 2024

Front. Immunol.

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IntroductionA potential overlap in symptoms between post-acute COVID-19 syndrome and post-COVID-19 vaccination syndrome has been noted. We report a paired description of patients presenting with similar manifestations involving the central (CNS) or peripheral nervous system (PNS) following SARS-CoV-2 infection or vaccination, suggesting that both may have triggered similar immune-mediated neurological disorders in the presence of anti-idiotype antibodies directed against the ACE2 protein.Patients and methodsFour patients exhibited overlapping neurological manifestations following SARS-CoV-2 infection or vaccination: radiculitis, Guillain–Barré syndrome, and MRI-negative myelitis, respectively, sharing positivity for anti-ACE2 antibodies. Autoantibodies against AQP-4, MOG, GlyR, GAD, and amphiphysin, onconeural antibodies for CNS syndromes, and anti-ganglioside antibodies for PNS syndromes tested negative in all patients.DiscussionAnti-idiotype antibodies against ACE2 have been detected in patients who recovered from COVID-19 infection, and it has been hypothesized that such antibodies may mediate adverse events following SARS-CoV-2 infection or vaccination, resulting in the activation of the immune system against cells expressing ACE2, such as neurons. Our data reveal clinically overlapping syndromes triggered by SARS-CoV-2 infection or vaccination, sharing positivity for anti-ACE2 antibodies. Their presence, in the absence of other classic autoimmune markers of CNS or PNS involvement, suggests that they might play an active role in the context of an aberrant immune response.ConclusionAnti-idiotype antibodies directed against ACE2 may be triggered by both SARS-CoV-2 infection and vaccination, possibly contributing to neurological autoimmune manifestations. Their pathogenic role, however, remains to be demonstrated in large-scale, more structured studies.

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Spastic Paraparesis After SARS-CoV-2 Infection Without Radiological Changes

Cited by 3 publications

References 14 publications

Case report: MRI-negative myelitis following COVID-19 with SEP abnormalities: a case series and literature review

Case report: MRI-negative myelitis following COVID-19 with SEP abnormalities: a case series and literature review

Atypical and delayed spinal cord MRI features of COVID-19-associated myelopathies: a report of four cases and literature review

Post-SARS-CoV-2 infection and post-vaccine-related neurological complications share clinical features and the same positivity to anti-ACE2 antibodies

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