Table 1.
Demographic, clinical, radiological, and laboratory findings of the reported patients with COVID-19 vaccine-associated myelitis.
| First Author/Country | Age/Sex | Comorbidities | Name of vaccine | Type of vaccine | Dose of vaccine | The interval between the vaccine and neurological symptoms onset(days) | The interval between the start of neurological symptoms to maximum disability (days) | TM clinical symptoms/neurological examinations | TM MRI features | Complete or incomplete TM (width* of the lesion)/longitudinal extension of the lesion⁎⁎ | Treatment | Results of paraclinics | Recovery at the last follow-up¶ |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1.Sriwastava et al.10/ USA | 67/F | Negative | Moderna(m-RNA 1273) | mRNA-based vaccine | First | 1 | 4 | Lower extremities weakness with muscle strength of grade 4/5. Reflexes were brisk at the knee. | Longitudinally extensive lesion from C1 to C3 with patchy enhancement. | Incomplete/ LETM | IVIg and PLEX. | CSF showed normal protein, glucose, and no pleocytosis. NMO, MOG, and OCB were negative. | Partial recovery |
| 2.Sepahvand et al.11 /Iran | 71/M | DM, HTN, IHD | Sinopharm(BBIBP-CorV) | Inactivated vaccine | First | 5 | 4 | Left hemiparesis (muscle strength of grade 3/5), urinary retention, hypoesthesia of the right upper and lower limbs and right side of the trunk, as well as impaired position and vibration senses and positive Babinski sign in the left lower limb. | Longitudinally extensive lesion from the medulla to C3. | Incomplete/LETM | MTP 6 gs followed by oral prednisolone. | CSF showed normal protein, glucose, and no pleocytosis. NMO, MOG, OCB, and vasculitis were negative. | Good recovery |
| 3.Tan et al.12/Malaysia | 25/F | Negative | ChAdOx1 nCOV-19 vaccine | Viral vector | First | 5 | 11 | Lower limbs myalgia followed by lower extremities weakness (muscle strength of grade 3/5), exaggerated deep tendon reflexes at the knees and ankles, bilateral positive Babinski sign, numbness and allodynia below the T8 spinal level, and urinary retention. | Multi-segment T2W hyperintensities (T3-T5, T7-T8, and T11-L1), showed variable cord enhancement post-contrast at T7-T8 lesions. |
Incomplete/LETM | MTP 5 gs | CSF showed no pleocytosis and normal glucose with an elevated protein of 546 mg/L (normal range: 150 −400). OCB, NMO, MOG, and vasculitis were negative. | Good recovery |
| 4.Corrˆea et al.13/ Brazil |
65/M | Negative | ChAdOX1 nCoV-19 vaccine | Viral vector | First | 8 | NM | Tetraparesis | Hyperintense lesion extending from C4-C6 with no contrast enhancement. | Incomplete/LETM | MTP 5 gs followed by tapering oral prednisolone. | CSF showed no pleocytosis, normal CSF glucose with an elevated protein of 70 mg/dl, and a negative infectious myelopathy panel (toxo-plasmosis, influenza, HSV, VZV, CMV, and syphilis). OCB, NMO, MOG, and vasculitis were negative. | Good recovery |
| 5.Vegezzi et al.14/Italy | 44/F | Negative | ChAdOx1 nCoV-19 vaccine | Viral vector | First | 4 | 3 | Paraparesthesia and numbness in lower extremities as well as reduced light touch and pinprick up to the ankles and brisk deep tendon reflexes in the lower limbs. | Hyperintensities in posterior paramedian at T7-T8 and left lateral cord at T10-T11 with mild patchy enhancement. | Incomplete/TM | MTP 5 gs followed by tapering oral prednisolone 1 mg/kg/d | CSF showed mild lymphocytic pleocytosis (6cells/µl), mildly elevated protein (76.7 mg/dl), and negative viral myelitis panel (HSV-1/2, VZV, Enterovirus, EBV, and CMV). NMO, OCB, MOG, and vasculitis were negative. | Good recovery |
| 6.Hsiao et al.15/Taiwan | 41/M | DM | ChAdOx1 nCoV-19 vaccine | Viral vector | First | 21 | 21 | Left peripheral facial palsy that completely resolved and followed by paresthesia, and loss of sensation in lower limbs (loss of pinprick sensation below T4 bilaterally, loss of joint position, and vibration over both lower limbs), asymmetrical lower extremities weakness (LT>RT), as well as increased bilateral knee reflexes. | Hyperintense lesion with contrast enhancement over the spinal cord at the T1 to T6. | Incomplete/LETM | MTP 5 gs followed by tapering oral prednisolone 1 mg/kg/d. | CSF showed mild lymphocytic pleocytosis (WBC: 11 cells/ul), mildly elevated protein (44.3 mg/dl), and a negative infectious myelopathy panel. Vasculitis, and NMO were negative. | Good recovery |
| 7.Pagenkopf et al.16/Germany | 45/M | Atopic dermatitis | ChAdOx1 nCoV-19 vaccine | Viral vector | First | 8 | 4 | Thoracic back pain with urinary retention followed by flaccid tetraparesis dominantly in lower limbs with sensory level at T9. | Longitudinally extensive lesion from C3 to T2 without gadolinium enhancement. | Complete/ LETM | MTP 5 gs followed by oral tapering prednisolone. | CSF showed PMN pleocytosis of 481 cells/μl (67% PMN), increased protein (140 mg/dl), increased lactate (3,98 mmol/l) and decreased glucose (CSF/serum ratio 0,43), and negative infectious myelopathy panel (cryptococcus, E-coli, isteria monocytogenes, neisseria meningitidis, streptococcus agalactiae, streptococcus pneumonia,haemophilus influenza, HSV1/2, VZV, HHV-6, CMV, EBV, tick- borne encephalitis, neuroborreliosis, enteroviridae, coxsackie, west nile virus, mycoplasma, tuberculosis, syphilis, HIV, hepatitis B and hepatitis C). OCB,, NMO, MOG, vasculitis, and autoimmune panel (Hu, Ri, ANNA-3, Yo, Tr, Myelin, Ma/Ta, GAD65, Amphiphysin, glutamate receptors of type NMDA and AMPA, GABA-a- receptor, GABA-b-receptor, LGI1, CASPR2, ZIC4, DPPX, Glycin- receptor, mGluR1, mGluR5, GluRD2, Rho GTPase, ITPR1, CARPVIII, Homer 3, Revoverin, Neurochondrin, Flotillin, and IgLON5) were negative. B12 serum level was normal. | Good recovery |
| 8.Notghi et al.17/UK | 58/M | DM, Pulmonary sarcoidosis | ChAdOx1 nCoV-19 vaccine | Viral vector | First | 7 | 7 | Progressive numbness of lower limbs (severe allodynia up to neck level and absence of vibration sensation below the groin), and urinary retention followed by weakness of lower limbs and inability to walk. | First: Longitudinally extensive lesion from T2 to T10 with foci of gadolinium enhancement; Second with one-week interval without treatment: extension of the lesion from C1 to T10 with no gadolinium enhancement. |
Complete/ LETM | MTP 5 gs followed by 5 sessions of PLEX followed by tapering oral prednisolone | CSF showed elevated protein 168 mg/dL with lymphocytic pleocytosis (11 cells/ul) and negative infectious myelopathy panel (HIV, HTLV-1, borrelia, hepatitis B&C, syphilis, HHV-6, mycoplasma). OCB in CSF and serum was similar. Vasculitis, MOG, NMO, and autoimmune panel (antiHu-YO, Ri) were negative. ACE, B12, copper, and folate levels were normal. FDG-PET scan demonstrated no active sarcoidosis nodule. | Partial recovery |
| 9.Gao et al.18/Taiwan | 76/F | HTN, Right-sided impaired hearing | Moderna(m-RNA 1273) | mRNA-based vaccine | First | 2 | 1 | Right upper and lower limbs and sacral paresthesia (decreased proprioceptive sensation below the right T4 dermatome), as well as gait unsteadiness with preserved muscle strength. The deep tendon reflex of the right limbs were relatively brisk. The Babinski sign showed a right extensor plantar response. | Longitudinally extensive intramedullary hyperintensity in the cervical cord at the C2–C5 levels on T2W images with contrast ring enhancement at the C3 level. | Incomplete/LETM | MTP 5 gs followed by tapering oral prednisolone. | CSF showed mild pleocytosis (15cells/µL) with neutrophil predominance (73%) and increased protein levels (57.2 mg/dL; normal limit: 15–45 mg/dL). CSF RPR, treponema pallidum hemagglutination, HIV, infectious myelopathy panel, and cytology were all negative. Vasculitis, NMO, and OCB were negative. B12 was deficient (131, >211). | Good recovery |
| 10.Malhotra et al.19/India | 36/M | Negative | ChAdOx1 nCoV-19 vaccine | Viral vector | First | 8 | NM | Abnormal sensation in lower limbs ascending to manubrium sterni, exaggerated deep tendon reflexes in lower limbs with extensor plantar responses. |
Hyperintense lesion at the dorsal aspect of cord at the level of C6-C7 with ring enhancement. | Incomplete/TM | MTP 5 gs | CSF showed mildly elevated protein (54 mg/dl) with no pleocytosis and a negative infectious myelopathy panel. NMO, MOG, and vasculitis were negative. | Good recovery |
| 11.Khan et al.20/USA | 67/F | CAD, CKD, Neuropathy, Colon rupture | Moderna(m-RNA 1273) | mRNA-based vaccine | First | 1 | NM | Bilateral upper and lower extremities weakness (RT>LT)(muscle strength of grade 3/5 and 4/5 in the right lower and upper extremities, respectively; tingling in the right lower extremity and bilateral loss of vibration up to the ankle; Exaggerated deep tendon reflexes in lower limbs with bilateral positive Babinski signs. | Hyperintense lesion in the upper cervical spine and cord edema extending from C1-C3 with patchy post-contrast enhancement. | Incomplete/LETM | MTP 3 gs followed by PLEX 5 sessions | CSF showed cell count 2, glucose 77 mg/dl, serum glucose 125 mg/dl, CSF protein 56 mg/dl, negative infectious myelopathy panel (SARS-COV-2 RT-PCR, gram stain, culture, Cryptococcus, HSV, and VDRL). OCB in CSF and serum was similar. Autoimmune and paraneoplastic panel, NMO, MOG, vasculitis, HTLVI/II, and HIV were negative. | Good recovery |
| 12.Erdem et al.21/Turkey | 78/F | HTN, DM, Breast cancer in complete remission | Sinopharm(BBIBP-CorV) | Inactivated vaccine | Second | 21 | 1 | Bilateral upper and lower extremities weakness(muscle strength of 0/5 at the right upper limb, 4/5 at the left proximal upper limb, 0/5 at the left distal upper limb, 4/5 at both lower limbs), difficulty in ambulating, paresthesias, and hypoesthesia of bilateral upper extremities, as well as decreased vibratory senses in bilateral lower extremities, urinary retention, and bilateral positive Babinski signs. |
Longitudinally extensive intramedullary T2W hyperintensity from the C1 to the T3. | Complete/ LETM | MTP 4 gs, PLEX 5 sessions. | CSF showed a normal cell count 2cells/µl with elevated protein level (56 mg/dL) with normal glucose. NMO, MOG, Vasculitis, OCB and tumor markers were negative; IgG index, B12, and ACE were normal. | Partial recovery |
| 13.Hirose et al.22/Japan | 70/M | HTN, Hyperuricemia, Alcoholic liver cirrhosis | Moderna(m-RNA 1273) | mRNA-based vaccine | First | 7 | NM | Bilateral lower extremities hypoesthesia (impaired bilateral perceptions to pinprick predominantly on the left side, and vibration predominantly on the right side below the level of the 8th thoracic dermatome), and mild paraparesis predominantly on the right side (muscle strength of grade 4/5); exaggerated deep tendon reflexes in lower limbs with bilateral positive Babinski signs. | Multiple high-intense areas on the T2W image located at the T1/2 and T 5/6 vertebral levels with weak gadolinium enhancement. |
Incomplete/TM | MTP 5 gs followed by tapering oral prednisolone. | CSF showed a normal white blood cell count (1 cell/μL), an increased level of proteins (52 mg/dL), and negative HSV, VZV, and autoimmune panel (Amphiphysin, Hu, Yo, CV2, Ri, Ma2/Ta, recoverin, Tr, GAD65, NMDAR, AMPAR, GABAbR, LGI1, Casper2, IgLON5, and DPPX); NMO, MOG, HIV, HTLV-1, and vasculitis were negative; OCB was positive. | Good recovery |
| 14.Tahir et al.23/USA | 44/F | Negative | Janssen(Johnson & Johnson)(Ad26.COV2.S) | Human adenovirus vector vaccine | First | 7 | 2 | Low back pain, numbness (decreased vibration in bilateral toes) and mild paresthesia in the neck and abdomen, exaggerated deep tendon reflexes in bilateral upper and lower extremities, positive Babinski signs, and urinary retention; Muscle strengths were preserved. | The longitudinally extensive hyperintense lesion from the C2–3 segment into the upper thoracic spine. | Incomplete/LETM | MTP 3 gs followed by PLEX 5 sessions. | CSF showed a white blood cell count of 100 cells/ul with 96% lymphocytes, 3% monocytes, and 1% eosinophils, glucose 71 mg/dL, protein 43 mg/dL; CSF bacterial, viral, and fungal cultures were negative; OCB, NMO, and vasculitis were negative. | Good recovery |
| 15.Miyaue et al.24/Japan | 75/M | HTN, HLP, Prostate cancer | Pfizer(BNT162b2) | mRNA-based COVID-19 vaccine | First | 3 | 11 | Ascending paresthesia followed by low back pain, reduced sensation during urination and defecation (total sensory loss below the level of the umbilicus), severe weakness in both legs(paraplegia), and loss of deep tendon reflexes in both legs. | The longitudinally extensive hyperin-ense lesion from the lower thoracic to the lumbar spine with no gadolinium enhancement. | Complete/ LETM | MTP 6 gs and PLEX 7 sessions followed by oral prednisolone 1 mg/kg/d. | CSF showed pleocytosis (33 cells/μL with 54% lymphocytes), an elevated protein level (155 mg/dL) with markedly elevated MBP (8580 pg/mL); NMO, MOG, and autoimmune panel (amphiphysin, CV2, PNMA2 (Ma2/Ta), Ri, Yo, u, recoverin, SOX1, titin, zic4, GAD65, and Tr) were negative. | Poor recovery |
| 16.Fujikawa et al.25/USA | 46/F | B12 deficiency | Moderna(m-RNA 1273) | mRNA-based vaccine | First | 2 | 4 | Constant, shooting, upper back pain in between her shoulder blades that radiated to her arms and lower chest, paresthesia distal to the T10 dermatome (decreased sensation to light touch and sharp materials), and bilateral lower extremities weakness (proximal and distal left lower-extremity strength ⅗ and right lower-extremity strength ⅘), followed by partial urinary retention. Also, there was hyporeflexia of the bilateral ankle, patella, and biceps deep tendon reflexes. | Hyperintense lesion involving the central gray matter at C6-T2 without enhancement. | Incomplete/LETM | MTP 5 gs followed by tapering oral prednisolone. | CSF showed no pleocytosis with normal protein level, negative VDRL, and Lyme IgM and IgG; NMO and vasculitis were negative; B12 level at 245 pg/mL (reference of range 254–1320 pg/mL). | Good recovery |
| 17.Kaulen et al.26/Germany | 55/F | Negative | Pfizer(BNT162b2) | mRNA-based COVID-19 vaccine | First | 3 | NM | Hypoesthesia in lower extremities. | Hyperintense T8 myelitis, mild homogeneous contrast uptake. | NM/TM | Wait and watch | CSF showed 8 lymphocytes, and positive OCB; Anti-SS‐A, SS‐B, anti gangliosidoses antibody panel, autoimmune panel (Hu, Ri, Yo PCA‐2 and Tr/DNER‐IgG, myelin, Ma/Ta, GAD65, amphiphysin, NMDA‐R, AMOA‐R, GABAA/B‐R, LGI2, CASPR2, ZIC3, ZIC4, DPPX, glycin‐R, mGluR1, mGluR5, Rho‐GTPase activating protein 26, ITPR1, homer 3, recoverin, neurochondrin, GluRD2, flotillin 1/2, IgLON5, PNMA2, SOX1, titin, Zic4, GAD65, VGKC, SOX‐1, PCA‐2 antibodies), myositis panel (ANA, Mi‐2 alpha, Mi‐2 beta, TIF1 gamma, MDA5, NXP2, SAE1, Ku, PM100, PM75, Jo‐1, SRP, PL‐7, PL‐12, EJ, OJ, Ro‐52, cN‐1A IgG), NMO, and MOG were negative. | Partial recovery |
| 18.Kaulen et al.26/Germany | 34/F | Negative | ChAdOx1 nCoV-19 vaccine | Viral vector | First | 14 | NM | Ascending hypoesthesia up to T9, and weakness of the right leg. | Hyperintense lesion T 4–9 with contrast medium enhancement. | NM/LETM | MTP | CSF showed 5 lymphocytes, and positive OCB; Anti-SS‐A, SS‐B, anti gangliosidoses antibody panel, autoimmune panel (Hu, Ri, Yo PCA‐2 and Tr/DNER‐IgG, myelin, Ma/Ta, GAD65, amphiphysin, NMDA‐R, AMOA‐R, GABAA/B‐R, LGI2, CASPR2, ZIC3, ZIC4, DPPX, glycin‐R, mGluR1, mGluR5, Rho‐GTPase activating protein 26, ITPR1, homer 3, recoverin, neurochondrin, GluRD2, flotillin 1/2, IgLON5, PNMA2, SOX1, titin, Zic4, GAD65, VGKC, SOX‐1, PCA‐2 antibodies), myositis panel (ANA, Mi‐2 alpha, Mi‐2 beta, TIF1 gamma, MDA5, NXP2, SAE1, Ku, PM100, PM75, Jo‐1, SRP, PL‐7, PL‐12, EJ, OJ, Ro‐52, cN‐1A IgG), NMO, and MOG were negative. | Partial recovery |
| 19.Mclean et al.27/USA | 69/F | Cancer cervix, Hypothyroidism | Pfizer(BNT162b2) | mRNA-based vaccine | First | 2 | 1 | Bilateral lower extremities, handgrip and finger extension weakness, paresthesia extended from lower extremities to both hands, and urinary incontinence. Also, deep tendon reflexes were noted to be slightly exaggerated. |
Extensive T2W signal abnormalities were seen particularly in the anterior aspect, as well as the mid-cord extending from C3–4 down to T2–3. | Incomplete/LETM | MTP 5 gs. | CSF showed normal analysis, negative OCB, and infectious myelopathy panel, including (VDRL, HSV, and Lyme); NMO and MOG were negative; TSH, folate, SPEP, UPEP, ESR, ANA, HIV, rheumatoid factor, RPR, hepatitis screening, ade-novirus antibody, ACE, anti-dsDNA, ANCA, CMV, copper, EBV, zoster, West-Nile virus, enterovirus, HTLV-1, Sjogren's, vitamin E, and autoimmune panel (anti-Hu, anti CV2, anti amphiphysin) were normal. | Partial recovery |
| 20.Alabkal et al.28/Canada | 26/F | Pancreatitis | Pfizer(BNT162b2) | mRNA-based vaccine | First | 3 | 12 | Progressive saddle anesthesia and bilateral paresthesias, numbness, and intermittent allodynia ascending the plantar aspects of her feet up the posterior legs, extending to the perineum (Sensation to temperature, pinprick, and proprioception symmetrically decreased in S1-S4 distribution including the soles of the feet but with posterior leg sparing on objective testing) followed by lack of sensation with defecation, urination, wiping, and sexual intercourse. Also, deep tendon reflexes were brisk, and muscle strength of the right extensor hallucis longus was grading of 4+/5. |
Short segment T2W hyperintensity with diffuse enhancement at T5. | Incomplete/TM | MTP 5 gs. | CSF showed pleocytosis(19cells/ul, 98%lymphocyte), normal protein (0.34 g/l), IgG index (0.68), and negative infectious myelopathy panel (CSF bacterial and fungal cultures, acid-fast bacilli, cryptococcal antigen, HSV, VZV, enterovirus, Borrelia burgdorferi, and syphilis); NMO, MOG, rheumatologic panel (ANA, C3, C4, rheumatoid factor), serum protein electrophoresis, and HIV were negative. | Partial recovery |
| 21.Fitzsimmons et al.29/USA | 63/M | Negative | Moderna(m-RNA 1273) | mRNA-based vaccine | Second | 1 | 1.5 | Aching and slight numbness in the calves and ankles of both legs, more prominent in the left leg, episode of an involuntary erection followed by difficulty in ambulation, urinary retention, constipation, and progression of numbness to both buttocks and back of the thighs, and inability to stand. Also, patellar and Achilles reflexes were brisk. |
Increased T2W signal intensity in the distal thoracic spinal cord and conus with questionable associated enhancement. | NM/LETM | IVIg 0.5 g/kg/d for 2 days, MTP 5 gs followed by 1 mg/kg/day oral prednisolone. | CSF showed 3 nucleated cells, normal protein 37 mg/dl, and glucose 74 mg/dl; Autoimmune antibody panel NMO, MOG, vasculitis, and OCB were negative except for mild elevated anti-SSA antibody. | Partial recovery |
| 22.Nakano et al.30/Japan | 85/M | Negative | Pfizer(BNT162b2) | mRNA-based vaccine | Second | 3 | 12 | Progressive gait disturbance (proximal-dominant weakness (RT>LT), numbness in lower extremities (distal-dominant hypoesthesia in the lower extremities), and urinary retention. Also, hyporeflexia in both upper and lower limbs was noted. |
Longitudinally hyperintense lesion at the T3–5 vertebral levels on T2W imaging. | Incomplete/LETM | 2 courses of 0.5 gram MTP for 3 days followed by prednisolone 40 mg/day | CSF showed predominantly monomorphonuclear pleocytosis (11 cells/μL), with elevated protein levels (120 mg/dL), normal IgG index(0.67), normal MBP (58pg/ml), negative OCB and CSF cytology; NMO was negative. | No improvement |
| 23.Spataro et al.31/Italy | 20/F | Negative | ChAdOx1 nCoV-19 vaccine | Viral vector | First | 3 | 12 | Muscle tenderness, weakness (muscle strength proximally (iliopsoas and quadriceps) and distally (ankle dorsiflexion and plantar flexion) 2–3/5), bilateral legs paresthesia (Tactile and pinprick sensation was decreased from T4 dermatome downward), and urinary retention. Also, mild spasticity, very brisk patellar and achilles tendon reflexes, and equivocal Babinski signs were noted bilaterally. | Normal brain and spinal MRI | Negative/ Negative | MTP 5 gs followed by betamethasone IM injection 4 mg for consecutive 15 days. | CSF showed increased protein, normal glucose, and 2 cells/µL (primarily lymphocytes). ANA and anti-dsDNA were negative. | Good recovery |
| 24.Cabral et al.32/Portugal | 33/M | Negative | Pfizer(BNT162b2) | mRNA-based vaccine | Second | 2 | 2 | Progressive weakness of the lower limbs (proximal muscle strengths of 4+ and 4 in the left and right legs, respectively), numbness in lower limbs (decreased thermic sensation below the T12), urinary retention, and nocturnal low back pain. Also, achilles deep tendon reflexes were brisk and plantar reflexes were equivocal. |
Normal brain and spinal MRI. | Negative/ Negative | Negative | CSF showed mononucleated pleocytosis (24 cells/ µL) and mild hyperproteinorrhachia (56 mg/dL); OCB was negative. | Good recovery |
| 25.Khan et al.33/Pakistan | 61/F | Asthma, HTN | Sinopharm (BBIBP-CorV) | Inactivated vaccine | Second | 4 | NM | Sudden onset of abnormal sensations (hypoesthesia in the upper and lower limbs) and weakness in bilateral upper and lower limbs. Neurological examination revealed upper motor neuron disease signs, including hyperreflexia, hypertonia, and spasticity, in both upper and lower extremities. |
A hyperintense lesion in C5–6 with contrast enhancement. | NM/TM | MTP 1 g/day | CSF showed normal analysis; NMO, ANA, and RF were negative. | Good recovery |
| 26.Maroufi et al.34/Iran | 31/F | Hyperthyroidism during pregnancy | ChAdOx1 nCoV-19 vaccine | Viral vector | First | 21 | 14 | Progressive lower limbs paraparesis (strength +4/5 in the right lower limb and 3/5 in the left lower limb) associated with paresthesia and pain (decreased pinprick sensation in lower limbs, impaired proprioceptive sensation in bilateral toes, and saddle anesthesia) more severe on the left side as well as urinary retention and fecal incontinence. | Cord expansion and hyperintense lesion of the spinal cord from T10 to L1 segment with heterogeneous enhancement. | NM/LETM | MTP 1 gram for 7 days followed by tapering oral prednisolone 50 mg. | CSF showed pleocytosis(40 cells/ µL with 97% lymphocyte), elevated protein (62 mg/dl), normal sugar and lactate; ACE, OCB, NMO, MOG, paraneoplastic and rheumatologic panel were negative. | Good recovery |
| 27.Eom et al.35/Korea | 81/M | HTN, DM | Pfizer(BNT162b2) | mRNA-based vaccine | Second | 3 | 14 | Bilateral hand weakness (strength 2/5), numbness/paresthesia in both hands and fingers in association with exaggerated deep tendon reflexes. | High signal intensity and multifocal nodular enhancement from the C1 to C3. | Incomplete/TM | MTP 1 gram for 5 days followed by tapering oral prednisolone | CSF showed normal analysis; NMO, MOG, vasculitis, and paraneoplastic panel were negative. | Partial recovery |
| 28.Eom et al.35/Korea | 23/F | Negative | Pfizer(BNT162b2) | mRNA-based vaccine | First | 21 | 3 | Sudden onset tingling sensation (normal sensory exam) in both thighs followed by weakness of both legs (strength 1/5) and urinary retention. | High signal intensity without contrast enhancement at the anterior portion of the conus medullaris. | Incomplete/TM | MTP 1 gram for 5 days followed by tapering oral prednisolone. | CSF showed normal analysis; NMO, MOG, and vasculitis were negative. | Good recovery |
| 29.Netravathi et al.36/India | 50/F | NM | ChAdOx1 nCoV-19 vaccine | Viral vector | First | 28 | 21 | Bilateral feet paresthesias (decreased distal vibration sense) in association with lower limbs weakness (finger extensor). | Focal cervical syrinx (C7-T1) and demyelination across C6. | NM/TM | MTP 1 gram for 5 days followed by tapering oral prednisolone. | CSF showed (2 cells/ µL with 100% lymphocyte), protein (28 mg/dl), and normal glucose. PCNA was mildly elevated. NMO, MOG, and ANCA were negative. | Good recovery |
| 30.Netravathi et al.36/India | 31/M | NM | ChAdOx1 nCoV-19 vaccine | Viral vector | First | 14 | 5 | Bladder disturbances followed by progressive numbness of lower limbs (decreased sensations below L1) and lower limbs weakness(strength1/5). | Long segment cervicothoracic hyperintensity with subtle enhancement. | NM/LETM | MTP 1 gram for 5 days and 7 sessions of PLEX followed by oral prednisolone and Rituximab 1 gram. | CSF showed PMN pleocytosis (370 cells/ µL), elevated protein (174 mg/dl), and normal glucose; NMO, MOG, and vasculitis panel were negative. | Good recovery |
| 31.Esechie et al.37/USA | 58/M | SCLC on atezolizumab and prophylactic whole brain radiation, HTN, BPH, back pain on the spinal stimulator | Moderna(m-RNA 1273) | mRNA-based vaccine | Second | 1 | 2 | Acute onset of lower extremities weakness (strength 0/5) and loss of sensation from his chest down to his lower extremities (diminished sensation to all modalities below the left T4 and the right T5 sensory dermatome). He also had urinary retention. | A large gadolinium-enhancing lesion in the cervicothoracic cord spanning from C7 to T7; MRI of the brain revealed small enhancing lesions in the left frontal lobe and both occipital lobes consistent with metastasis to the brain. | Complete/ LETM | MTP 1 gram for 5 days and 3 sessions of PLEX. | CSF showed WBC (25 cells/μl), protein 94 mg/dl, normal glucose, negative OCB, and normal IgG index; NMO, MOG, and infectious myelopathy panel were negative. | Partial recovery |
⁎
Complete and incomplete are defined as the entire and partial width of the spinal cord being affected, respectively.
⁎⁎
LETM is defined as a spinal cord lesion extending over three or more vertebral segments.
¶
We consider the modified Rankin scale (MRS) at the last follow-up of the reported patients as an indicator of he rate of recovery (MRS < 3 as a good recovery, and MRS ≥3 as a partial recovery).
TM: transverse myelitis; MRI: magnetic resonance imaging; F: female; C: cervical; LETM: longitudinally extensive transverse myelitis; IVIg: intravenous immunoglobulin; PLEX: plasma exchange; CSF: cerebrospinal fluid; NMO: neuromyelitis optica; MOG: myelin oligodendrocyte glycoprotein; OCB: oligoclonal bands; M: male; DM: diabetes mellitus; HTN: hypertension; IHD: ischemic heart disease; MTP: pulse methylprednisolone; T2W: T2-weighted; T: thoracic; L: lumbar; NM: not mentioned; HSV: herpes simplex virus; VZV: varicella-zoster virus; EBV: Epstein-Barr virus; CMV: cytomegalovirus; LT: left; RT: right; HHV-6: human herpesvirus 6; HIV: human immunodeficiency virus; HTLV-1: human T-lymphotropic virus type 1; FDG-PET scan: fluorodeoxyglucose-positron emission tomography scan; CAD: coronary artery disease; CKD: chronic kidney disease; SARS-CoV-2: severe acute respiratory syndrome-coronavirus-2; VDRL: venereal disease research laboratory test; ACE: angiotensin-converting enzyme; HLP: hyperlipidemia; TSH: thyroid stimulating hormone; SPEP: serum protein electrophoresis; UPEP: urine protein electrophoresis; ESR: erythrocyte sedimentation rate; RPR: Rapid plasma Reagin; ANA: anti-nuclear antibody; S: sacral; MBP: myelin basic protein; RF: rheumatoid factor; PCNA: proliferating cell nuclear antigen; SCLC: small cell lung cancer; BPH: benign prostatic hyperplasia.