Clinical, radiological, and laboratory characteristics of 11 patients with myelitis following SARS-CoV-2 infection
| Case | Diagnosis | Symptoms | Time from infection to symptoms onset | MRI | Lumbar puncture | Treatment | Response | 1-year follow-up |
|---|---|---|---|---|---|---|---|---|
Case 1 (F, 25) | Myelitis involving posterior and lateral columns (cervical and thoracic) | Legs weakness (2/5 MRC), urinary urgency, voiding difficulty, and bowel constipation | 3 weeks | Posterior and lateral column damage at the cervical and thoracic levels | Cytosis 10 cells/mm3 Protein 0.213 g/L OCB type 1 | PLEX, IVMP Vitamin B12 | None (sent for rehabilitation) | Legs weakness (3/5 MRC), bladder and bowel symptoms persist |
Case 2 (F, 55) | Myelitis (С1) | Hands weakness (3/5 MRC) and neck numbness | 5 weeks | Lesion at the С1 | Cytosis 1 cell/mm3 Protein 0.287 g/L OCB type 2 | IVMP | Residual sensory disturbances | Total recovery |
Case 3 (M, 49) | Myelitis С2-С4 | Arms weakness (4/5 MRC), neck weakness, and Lhermitte sign | 4 weeks | Lesion at the С2-С4 | Cytosis 7 cells/mm3 Protein 0.662 g/L OCB type 1 | IVMP | Residual sensory disturbances | Residual sensory disturbances Radiologically stable |
Case 4 (M, 34) | Myelitis С3-С4 | Hands clumsiness, Lhermitte sign, and bilateral numbness up to shoulder | 4 weeks | Lesion at the С3-С4 | Cytosis 4 cells/mm3 Protein 0.282 g/L OCB type 1 | IVMP | Residual sensory disturbances Lhermitte sign persists | NA |
Case 5 (F, 42) | Myelitis С6 | Left arm weakness (3/5 MRC), legs weakness (4/5 MRC), left-sided numbness, Lhermitte sign | 3 weeks | Lesion at the С6 | Cytosis 2 cells/mm3 Protein 0.251 g/L OCB type 3 | IVMP | Residual sensory disturbances Lhermitte sign persists | Total recovery |
Case 6 (F, 52) | Myelitis С6-С7 | Right arm numbness, right arm burning, and Lhermitte sign | 5 weeks | Lesion at the С6-С7 | Cytosis 7 cells/mm3 Protein 0.513 g/L OCB type 1 | IVMP | Residual sensory disturbances | Total recovery |
Case 7 (M, 48) | LETM | Legs weakness (1/5 MRC), urinary urgency, voiding difficulty, and bilateral numbness up to abdomen | 3 weeks | Longitudinal lesion at the T4-T11 | Cytosis 1 cell/mm3 Protein 0.391 g/L OCB type 2 | PLEX IVMP | Residual sensory disturbances and legs weakness (3/5 MRC) | Lower limbs weakness (4/5 MRC) Radiologically stable |
Case 8 (F, 49) | MOG-Abs associated LETM | Legs weakness (4/5 MRC) and legs numbness | 5 weeks | Longitudinal lesion at the T5-T8 | Cytosis 1 cell/mm3 Protein 0.391 g/L OCB type 2 | IVMP | Residual sensory disturbances | Placed on Rituximab therapy Clinically and radiologically stable |
Case 9 (M, 49) | Multifocal myelitis (cervical) | Left arm numbness, left arm pain, and Lhermitte sign | 5 weeks | Multiple lesions at the С2-3, С4, and С5-6 | Cytosis 7 cells/mm3 Protein 0.347 g/L OCB type 2 | IVMP | Residual sensory disturbances | NA |
Case 10 (M, 37) | Myelitis involving posterior and lateral columns | Legs weakness (1/5 MRC) and legs paresthesia | 2 weeks | Posterior and lateral column damage throughout the spinal cord | Cytosis 10 cells/mm3 Protein 0.360 g/L OCB type 1 | PLEX IVMP Vitamin B12 | None (sent for rehabilitation) | Legs weakness (3/5 MRC) and less bladder and bowel symptoms |
Case 11 (F, 64) | Myelitis T4-T5 | Right leg weakness (3/5 MRC), right-sided numbness and pain, urinary urgency and voiding difficulty | 2 weeks | Lesion at the T4-T5 | Cytosis 2 cells/mm3 Protein 0.277 g/L OCB type 1 | IVMP | Residual sensory disturbances, right leg weakness (4/5 MRC), and persistent urinary urgency | NA |
F: female; M: male; С1: level of the 1st cervical vertebra; MRC: Medical Research Council; PLEX: plasma exchange; IVMP: intravenous methylprednisolone; NA: not available
