Table 2.

An overview of clinical features and outcomes of the previous and present care reports in patients diagnosed with transverse myelitis and COVID-19

Case report	Sample size	Age (years) and sex	COVID-19 clinical symptoms*	Severity of COVID-19 infection**	Confirmatory COVID-19 results			TM clinical symptoms	TM Tempo***	Interval between COVID-19 and TM (days)	TM MRI features	Significant laboratories data	Treatment		Outcome
					NP/OP PCR	Spiral chest CT	CSF PCR						COVID-19	TM
Rodríguez de Antonio et al. 11	One	40/F	-	-	+	NM	NM	Numbness and hypoesthesia in lower limbs and perineum, mild urination urgency, a moderate deficit of vibratory sensitivity in the ankles and knees	NM	NM	A central 7×4 mm non-expansile T2-weighted hyperintense signal in the T5-T6 level	OCB-, NMO-, MOG-, Vasculitis-, ACE-, CSF lymphocytic pleocytosis (20 cells/μL), with normal proteins (36 mg/dL)	-	IV MTP for five days	Complete recovery of the bladder and mild recovery of sensory function
Munz et al. 12	One	60/M	Respiratory	Moderate	+	+	-	Bladder dysfunction, progressive weakness of the lower limbs, hypesthesia below the T9 level, moderate spastic paraparesisAcute	8	Patchy hyperintensities of the thoracic myelon at Th9-10 and Th3-5 level	OCB-, NMO-, MOG-, autoimmune panel-, CSF lymphocytic pleocytosis (16 cells/μL) with elevated protein level (79 mg/dL)	NM	IV aciclovir and ceftriaxone, IV MTP (100 mg/d) ×5 days	Significant recovery with minor disability
Durrani et al. 13	One	24/M	Non-respiratory	Moderate	+	+	NM	Areflexia in the lower limbs with bilateral lower-extremity paraplegia and overflow urinary incontinence	NM	12	Non-enhancing T2-weighted hyperintense signal abnormality spanning from the 7th through the 12th thoracic level	NMO-, OCB-, vasculitis-, autoimmune panel-, CSF lymphocytic pleocytosis with normal protein	NM	IV MTP	Marked improvement
GÜLER et al. 14	One	14/F	-	-	+	-	NA	Right-sided hemiplegia	NM	0	A contrast-enhancing lesion causing expansion at the C2-C5 level	Vasculitis-, NMO-, OCB-, and CSF revealed no cell with increased protein (262 mg/dL)	-	IVIG (400 mg/Kg/day for five days), MTP (30 mg/Kg/day for seven days)	Significant recovery
Baghbanian et al. 15	One	53/F	NM	NM	+	+	-	Radicular low back pain and transient urinary incontinence, asymmetrical paraparesis 3/5 and 0/5 in the right-sided and left-sided lower limbs, respectively, with sensory level at T11-T12	Subacute14	Longitudinally extensive hyperintensity in the T8-T10 cord segments	OCB-, NMO-, MOG-, CSF lymphocytic pleocytosis (13 cells/μLl) with normal protein	NM	PlasmapheresisMarked recovery
Fumery et al. 16	One	38/F	Respiratory and non-respiratory	Mild	+	NM	-	Weakness of the lower limbs (MRC 4/5), hypoesthesia, and bladder dysfunction	Subacute9	T2 extensive hyper signal involving predominantly the grey matter of the cervical and thoracic regions of the spinal cord with no gad enhancement	Vasculitis-, NMO-, MOG-, OCB-, CSF lymphocytic pleocytosis (337 cells/μL) with elevated protein (78 mg/dL)	NM	IV MTP 8 grams	Significant recovery
Chow et al. 17	One	60/M	Respiratory and non-respiratory	Mild	+	+	NM	Urinary retention and constipation with progressive lower limbs weakness and gait impairment	Acute	16	A long segment of T2 hyperintensity in the spinal cord from T7 to T10 without contrast enhancement	NMO-, MOG-, autoimmune panel-, elevated CSF protein	NM	IV MTP 3 grams	Completely resolved
Shahali et al. 18	One	63/M	Respiratory and non-respiratory	Moderate	+	+	NM	Sudden weakness of both lower limbs with loss of sensation below the chest in association with constipation and urinary retention	Hyperacute4	An extensive increased T2 signal in the central gray matter and dorsal columns from C7 to T12 with a linear enhancement in the mid- and low-thoracic cord	NMO-, MOG-, OCB-, Vasculitis-, ACE-, CSF lymphocytic pleocytosis (96 cells/μL) with increased CSF protein (128 mg/dL)	HydroxychloroquineAzithromycin	ritonavir	IV MTP 3 grams, IVIG 25 grams/day for three days	Complete recovery
Kaur et al. 19	One	3/F	-	-	+	-	-	Progressive flaccid quadriparesis with loss of sensation and neurogenic respiratory failure requiring intubation	Acute	21	Swelling of the cervical spinal cord with T2-hyperintense edema involving most of the transverse aspect of the spinal cord extending from the lower medulla to the mid-thoracic level with no contrast enhancement.	NMO-, MOG-, autoimmune panel-, Vasculitis-, CSF PMN pleocytosis (42 cells/μL) with elevated protein (58 mg/dL)	NM	IV MTP (30 mg/kg/d) for 5 days, IVIG 2 gram/Kg, Plasmapheresis for seven sessions, Rituximab 375 mg/m2 for four doses	Severe disability
Present case	One	39/M	Respiratory and non-respiratory	Moderate	+	+	-	Numbness and paresthesia on feet that progressed to severe weakness in both lower extremities and loss of sensation to the level of the chest with urinary retention and constipation	Acute	12	A longitudinal extensive hyperintense lesion at the level of C2-T12 of the spinal cord with no gadolinium enhancement	NMO-, MOG-, OCB-, autoimmune panel-, vasculitis-, CSF normocellular with a normal protein level	RemdesivirDexamethasone	IV MTP 10 grams, Plasmapheresis for seven sessions	Slight recovery with severe disability

TM: Transverse myelitis; COVID-19: Coronavirus disease 2019; F: Female; M: Male; NP/OP: Nasopharyngeal and oropharyngeal; PCR: Polymerase chain reaction; CT: Computed tomography; CSF: Cerebrospinal fluid; NM: Not mentioned; NA: Not applied; OCB: Oligoclonal band; NMO: Anti-aquaporin-4 antibody; MOG: Anti-myelin oligodendrocyte glycoprotein; IV: Intravenous; MTP: Methylprednisolone; T: Thoracic; IVIG: IV immunoglobulin; PMN: Polymorphonuclear;

^*Non-respiratory: fever, headache, malaise, neurological symptoms, decreased level of consciousness, gastrointestinal symptom.

^**Severity of COVID-19 infection: mild (no need for hospital admission), moderate (hospital admission with no need of mechanical ventilation), severe (need mechanical ventilation).

^***TM Tempo: hyperacute (2-3 hours), acute (<48 hours), subacute (48 hours to 30 days).