Table 1.
Clinical, laboratory and neuroimaging features in COVID-19 patients with acute myelopathies. *: F-U, follow-up; follow-up evaluation is reported for each symptom within brackets, according to the following coding: P, persisting without substantial improvement; I, improved without full recovery; R, resolved. Follow-up timing is reported in number of weeks after onset. ** the patient’s neurological onset occurred 3 weeks after the occurrence of infectious COVID-19 symptoms in her family. # between infectious and neurological symptoms.
| Zanin et al.[7] | Zoghi et al.[8] | Sarma et al.[9] | Zhao et al.[10] | Aguila-Gordo et al.[11] | Abdelhady et al.[12] | Alketbi et al.[13] | |
|---|---|---|---|---|---|---|---|
| Subject | 54 y-o F | 21 y-o M | 28 y-o F | 66 y-o M | 50 y-o M | 52 y-o M | 32 y-o M |
| COVID-19 course | Severe | Moderate | Mild | Severe | Mild | Severe | Moderate |
| Neurologic onset / symptoms (F-U*, timing) | Sub-acute | Sub-acute | Acute | Sub-acute | Acute | Acute | |
| - Motor d. | N.E. | Tetraplegia (I, 2) | Paraplegia | Flaccid paraplegia (P, 2) | Paraplegia (N.S.) | Flaccid tetraplegia | Flaccid tetraplegia (I, 1) |
| - Sensory d. | N.E. | Mid-thoracic level (I, 2) | Upper-dorsal level (P, 1) | Mid-thoracic level (N.S.) | Mid-thoracic level (I, N.S.) | N.S. | – |
| - Sphincter d. | N.E. | Bladder (N.S.) | Bladder | Both (N.S.) | Bladder (N.S.) | N.S. | Bladder (I, 1) |
| - Other | Seizure, coma (R, 4) | Vomiting (R, 2) | Vomiting | – | – | Exitus after 5 days | – |
| Latency / Overlap # | “Several days”/Yes | 15 days/Yes | 1 week/Yes | 6 days/Yes | 1 day/Yes | 3 days/Yes | 2 days/Yes |
| SARS-CoV-2 RT-PCR (in-hospital swab) - Timing after onset: | Positive | Negative | N.P. | Positive | Positive | Positive | Positive |
| - Infectious | “Several days” | 14 days | – | 5 days | 4 days | 3 days | 2 days |
| - Neurological | Simultaneous | 4 days | – | Simultaneous | 3 days | Simultaneous | Simultaneous |
| Other COVID-19 supportive tests | IgG+ | Previous swab+ | |||||
| Brain imaging | MRI: Multiple white matter lesions | MRI: Corticospinal and splenial lesions | N.P. | CT: Normal | MRI: Normal | MRI: Normal | N.P. |
| Spine imaging – N of lesions |
MRI Multiple |
MRI Single |
MRI Single |
N.P. | MRI Normal |
MRI Single |
MRI Single |
| -Axial pattern | N.S. | N.S. | N.S. | – | – | Ventral horn grey matter | Grey matter |
| -Longitudinal extension | Medulla, C2, C3-T6 | Cervical LETM | LETM (medulla-conus) | – | – | Thoracic LETM | LETM (cervico-thoraco-lumbar) |
| -Enhancement | Absent | Absent | Absent | – | – | Absent | Absent |
| -Hemorrhage | Absent | Absent | Absent | – | – | Absent | Absent |
| -F-U (timing) | N.P. | N.P. | N.P. | N.P. | N.P. | N.P. | N.P. |
| CSF findings | N.P. | N.P. | |||||
| -Cells (n/mmc) | Normal | 150 → 250 Ly (3 d) | 125 Ly | – | Normal | “Lymphocytosis” | – |
| -Protein (mg/dl) | Normal | 281 → 111 (3 d) | Normal | – | Normal | “Hyperproteinorrachia” | – |
| -Glucose (mg/dl) | Normal | 34 | Normal | – | – | – | – |
| -OCBs | – | Absent | – | – | – | – | – |
| -SARS-CoV-2 RT-PCR | Negative | Negative | N.P. | – | Negative | Negative | – |
| Diagnosis | Acute demyelinating encephalomyelitis | Acute demyelinating encephalomyelitis | Acute myelitis | Acute myelitis | Acute myelitis | Acute flaccid myelitis | Acute myelitis |
| Treatment (dose, duration) | |||||||
| -Steroids | DEX (20 mg then 10 mg od, each 10 days) | – | M−P (N.S.) | DEX (10 mg od, 10 days) | DEX (N.S.) | + (N.S.) | M−P (1 g od, 5 days) |
| -IVIg | – | – | – | IVIg (15 g od, 7 days) | + (N.S.) | – | – |
| -P-E | – | 5 sessions | 2 sessions | – | – | – | – |
| -Rituximab | – | – | – | – | – | – | – |
| -Antimicrobials | Antiretroviral (N.S.) | Vancomycin, meropenem, acyclovir (N.S.) | – | Ganciclovir (0.5 g od, 14 days), lopinavir/ritonavir (5 days), moxifloxacin (400 mg od, 6 days), meropenem (1 g bid, 8 days) | Lopinavir/ritonavir (N.S.) | Acyclovir (N.S.) | Acyclovir 750 mg tid (N.S.) |
| - Other | HCQ (N.S.) | – | – | – | HCQ (N.S.) | – | Enoxaparin 40 mg od |
| Munz et al.[14] | Chow et al.[15] | Baghbanian et al.[16] | Zachariadis et al.[17] | Kaur et al.[18] | Sotoca et al.[19] | Maideniuc et al.[20] | Masuccio et al.[21] | Valiuddin et al.[22] | |
|---|---|---|---|---|---|---|---|---|---|
| Subject | 60 y-o M | 60 y-o M | 53 y-o F | 63 y-o M | 3 y-o F | 69 y-o F | 61 y-o F | 70 y-o F | 61 y-o F |
| COVID-19 course | Moderate | Moderate | Moderate | Moderate | Asymptomatic | Mild | Mild | Mild | Mild |
| Neurologic onset / symptoms (F-U*, timing) | Acute | Sub-acute | Acute | Sub-acute | Acute | Sub-acute | Sub-acute | Sub-acute | Sub-acute |
| - Motor d. | Lower limbs (I, 2) | Lower limbs (R, 1) | Distal lower limbs (I, N.S.) | Lower limbs (I, 4) | Four limbs (P, N.S.) | Bilateral hand and lower limbs (I, 4) | Lower limbs (I, 4) | Lower limbs (P, 2) | Lower limbs (P, 4) |
| - Sensory d. | Mid-thoracic level (I, 2) | Lower limbs (R, 1) | Mid-thoracic level (N.S.) | Mid-thoracic level (P, 4) | – | Bilateral hand and lower limbs (I, 4) | Lower limbs (I, 4) | Four limbs (P, 2) | Mid thoracic level (I, 4) |
| - Sphincter d. | Bladder (R, 2) | Both (R, 1) | Bladder (R, 1) | Both (P, 4) | – | Both (P) | Both (N.S.) | – | Both (P, 4) |
| - Other | – | – | – | – | Respiratory failure | – | – | – | – |
| Latency / Overlap # | > 1 week /No | 16 days /No | 2 weeks /No | 12 days /No | Unidentifiable ** | 8 days /No | 5 days /No | 5 days /No | 3 days /No |
| SARS-CoV-2 RT-PCR (in-hospital swab) - Timing after onset: | Negative | Negative | N.P. | Negative | Positive | Positive | Positive | Negative | Positive |
| - Infectious | >1 week | 18 days | – | 16 days | – | >1 week | 8 days | 25 days | 7 days |
| - Neurological | Simultaneous | 2 days | – | 4 days | Simultaneous | Simultaneous | 3 days | 10 days | 4 days |
| Other COVID-19 supportive tests | Previous swab+ | IgG+>IgA+>IgM+ Previous swab+ | Previous swab+ | IgM+ IgG + | IgG+ | ||||
| Brain imaging | MRI: Normal | MRI: Normal | MRI: Normal | MRI: Normal | MRI: Normal | MRI: Normal | MRI: Normal | MRI: Normal | N.P. |
| Spine imaging –N of lesions | MRI: Multiple | MRI: Single | MRI: Single | MRI: Normal findings | MRI: Single | MRI: Single | MRI: Single | MRI: Single | MRI: Single |
| -Axial pattern | Transverse | Centromedullary | N.S. | – | Transverse | – | Centromedullary | Posterior columns | Centromedullary |
| -Longitudinal extension | T3; T9 | LETM: T7-T10 | LETM: T8-T10 | – | LETM: medulla-T7 | LETM: medulla-C7 | LETM: C1-C7 | C7-T1 | LETM: C1-C7 |
| -Enhancement | Absent | Absent | N.S. | – | Absent | Patchy | Patchy | Absent | Absent |
| -Hemorrhage | Absent | Absent | N.S. | – | Patchy (F-U, 5 d) | Absent | Absent | Absent | Absent |
| -F-U (timing) | Persisting (6 d) | Resolved (10 d) | N.P. | – | Worsened (5 d) | Worsened (7 d) | – | Persisting (5 d) | N.P. |
| CSF findings | |||||||||
| -Cells (n/mmc) | 16 →3 Ly (12 d) | Normal | 13 Ly | 16 →36 Ly (6 d) | 282 RBC, 40N | 75 Ly | 312 RBC, 3 WBC | Normal | Normal |
| -Protein (mg/dl) | 79.3→73.4 (12 d) | 79 | Normal | 57.3→60 (6 d) | 58 | 283 | 87 | Normal | 87→153 (9 d) |
| -Glucose (mg/dl) | – | Normal | Normal | Normal | – | Normal | 73 | – | Normal |
| -OCBs | Absent | – | Absent | Absent | – | Absent | Absent | Mirror pattern | Absent |
| -SARS-CoV-2 RT-PCR | Negative | Negative | Negative | Negative | Negative | Negative | Negative | N.P. | Negative |
| Diagnosis | Post-infectious acute myelitis | Post-infectious acute myelitis | Post-infectious acute myelitis | Post-infectious acute myelitis | Post (?) infectious acute myelitis | Acute necrotizing myelitis | Post-infectious myelitis / AMAN | Post-infectious myelitis / AMAN | Acute myelitis / AMAN |
| Treatment (dose, duration) | |||||||||
| -Steroids | M−P (100 mg OD, N.S.) | M−P (1 g OD, 3 days) | – | N.S. (N.S., 5 days) | M−P (30 mg/kg, 5 days) | M−P (1 g OD, 5 days, 2 sessions) | M−P (1 g OD, 5 days) | – | M−P 1 g OD for 5 days |
| -IVIg | – | – | – | (0.4 g/kg, 5 days) | (0.4 g/kg, 5 days) | – | – | + (N.S.) | – |
| -P-E | – | – | + (N.S.) | – | 7 sessions | + (N.S.) | 5 sessions | + (N.S.) | 5 sessions |
| -Rituximab | – | – | – | – | 375 mg/m2 | – | – | – | – |
| -Antimicrobials | – | – | – | – | – | – | – | – | – |
Abbreviations: y-o, year-old; F, female; M, male; CNS, central nervous system; Ly, lymphocytes; CSF, cerebrospinal fluid; OCBs, oligoclonal bands; LETM, longitudinal elongated transverse myelitis; N.P., not performed; OD, omne in die; bid, bis in die; M−P, methylprednisolone; P-E, plasma exchange; DEX, dexamethasone; HCQ, hydroxychloroquine; IVIg, intravenous immunoglobulins.