TABLE 2.
Neuroimaging, CSF findings and ancillary investigations
| Reference | MRI spinal cord | MRI brain | CSF | NCS/EMG | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| T2 hyperintensity | Enhancement | Spinal cord subsegment | Lesion length (vertebral segments) | Pattern | Presence of pleocytosis (cell count) | Protein | Glucose | Pathogens | Other | |||
| Abdelhady [40] | + | – | Thoracic | 6 | Continuous | WNL | + | + | NA | Cultures neg, SARS‐CoV‐2 PCR neg | None | NA |
| AlKetbi [49] | + | – | Cervical, thoracic, lumbar | 23 | Patchy | NA | NA | NA | NA | NA | NA | NA |
| Baghbanian [50] | + | NA | Thoracic | 3 | Continuous | WNL | + (13/μl) | WNL | WNL | PCR for HSV, CMV and SARS‐CoV‐2 neg | No CSF‐specific OCBs, IgG index upper limit of normal, MOG/AQP4 Abs neg | NA |
| Chakraborty [51] | + | NA | Thoracic | 2 | Continuous | NA | WNL | + (71.4 mg/dl) | WNL | Ziehl–Neelsen and Gram‐stain neg, SARS‐CoV‐2 PCR neg | None | NA |
| Chow [52] | + | NA | Thoracic | 4 | Continuous | WNL | WNL | + (79 mg/dl) | WNL | Cultures neg, SARS‐CoV‐2 PCR neg | MOG/AQP4 Abs neg | NA |
| Durrani [53] | + | NA | Thoracic | 6 | Continuous | NA | + | WNL | WNL | NA | No CSF‐specific OCBs, IgG index normal, AQP4 Abs neg | NA |
| Giorgianni [54] | WNL | NA | NA | NA | NA | Tiny subacute frontal hemorrhage | WNL | WNL | + | SARS‐CoV‐2/VZV/HSV PCR, Borrelia Abs, microbial culture, and Tbc neg | None | NA |
| Kaur [19] | +/+, necrosis, hemorrhages | –/+ | Medulla, cervical, thoracic | 13 | Continuous | WNL | + (42/μl), 96% neutrophilic | + (58 mg/dl (15–45 mg/dl)) | NA | SARS‐CoV‐2, viral, and microbacterial panels neg | Including MOG/AQP4 Abs neg; hemorrhagic (282/mm3) | NA |
| Lisnic [55] | + | – | Cervical, thoracic | 9 | Continuous | WNL | WNL | WNL | WNL | SARS‐CoV‐2, viral, and bacterial tests neg | No CSF‐specific OCBs, MOG/AQP4 Abs neg | NA |
| Maideniuc [16] * Valiuddin [17]* | + | + | Medulla, cervical, thoracic, lumbar | 24 | Continuous | WNL | d10: WNL d21: WNL |
d10: + (87 mg/dl) d21: + (153 mg/dl) |
WNL | d10: SARS‐CoV‐2 negative, other viral pathogens not done, VDRL/culture neg | No CSF‐specific OCBs, IgG index normal, ganglioside Abs not tested, MOG/AQP4/anti‐neuronal Abs neg; d10: hemorrhagic (312/ul) | NCS/EMG: acute motor axonal neuropathy |
| Masuccio [20] | + | – | Cervical, thoracic | 3 | Continuous | WNL | WNL | WNL | NA | Viral and bacterial work‐up neg | Anti‐GD1b‐IgM pos, no CSF‐specific OCBs, viral/bacterial work‐up neg in serum | NCS/EMG: acute motor axonal neuropathy |
| Munz [22] | + | – | Thoracic | 3 plus 2 | Patchy | WNL | d1: + (16/μl) d6: + (27/μl) |
d1: + (79 mg/dl) d6: + (118 mg/dl) |
NA | HSV, VZV, HHV‐6, EBV, HEV, SARS‐CoV‐2 neg, anti‐SARS‐CoV‐2 IgG neg | No CSF‐specific OCBs, MOG/AQP4/anti‐neuronal Abs neg | NA |
| Paterson [42] | + | – | Thoracic, lumbar | > 4 | Patchy | WNL | + (10/μl) | + (70 mg/dl) | + | Culture and viral PCRs neg | No CSF‐specific OCBs | NCS/EMG: WNL |
| Rifino [21] | +, diffuse degeneration | – | NA | NA | NA | WNL | WNL | + | NA | PCR for bacteria/neurotropic viruses/SARS‐CoV‐2 neg, anti‐SARS‐CoV‐2 IgG pos | None | NCS/EMG: reduction of maximal voluntary activity; SEP/MEP lower limbs: bilateral medullar conduction block |
| Rifino [21] | Diffuse degeneration | – | NA | NA | NA | WNL | WNL | + | NA | PCR for bacteria/neurotropic viruses/SARS‐CoV‐2 neg, anti‐SARS‐CoV‐2 IgG pos | None | NCS/EMG: reduction of maximal voluntary activity; SEP/MEP lower limbs: bilateral medullar conduction block |
| Sarma [56] | + | + | Medulla, cervical, thoracic, lumbar | 24 | Continuous | NA | + (125/μl) | (+) | WNL | Gram‐stain and cultures unremarkable | Abs neg | NA |
| Sotoca [23] | +, necrosis, hemorrhages | + | Medulla, cervical, thoracic | 13 | Continuous | WNL | + (75/μl) | + (283 mg/dl) | WNL | Bacterial culture, viral multi‐PCR neg | No CSF‐specific OCBs, IgG index normal, MOG/AQP4/anti‐neuronal Abs neg | NA |
| Wong [24] | +, hemorrhages | NA | Rhomencephalic, medulla, cervical | NA | Continuous | T2 hyperintensity right inferior cerebellar peduncle, microhemorrhages | WNL | WNL | NA | Bacterial culture neg | MOG/AQP4 Abs neg | NA |
| Zachariadis [57] | WNL | NA | NA | NA | NA | WNL | d1: + (16/μl) d6: + (36/μl) |
d1: + (57.3 mg/dl) d6: + (60.0 mg/dl) |
WNL | Neg for bacteria and viruses including SARS‐CoV‐2 | MOG/AQP4/anti‐neuronal/anti‐ganglioside neg | NA |
| Zhao [18] | NA | NA | No MRI | No MRI | No MRI | Lacunar infarctions, atrophy | NA | NA | NA | NA | NA | NA |
Abbreviations: Ab, antibody; AQP4, aquaporin 4; CMV, Cytomegalovirus; CSF, cerebrospinal fluid; EBV Epstein‐Barr virus; GD1b, ganglioside 1b; HHV‐6, Human Herpesvirus‐6; Hepatitis E virus, HEV, SEP/MEP, somatosensory/motor evoked potentials; HSV, Herpes‐simplex virus (HSV); IgG, Immunoglobulin G; IgM, Immunoglobulin M; MOG, myelin oligodendrocyte glycoprotein; MRI, magnetic resonance imaging; NA, not available; neg, negative; NNCS/EMG, nerve conduction study/Electromyography; OCB, oligoclonal bands; PCR, polymerase chain reaction; pos, positive; Tb, tuberculosis; VDRL, Venereal Disease Research Laboratory; VZV, Varicella‐zoster virus; WNL, within normal limits.
*
Same case reported in two publications.