COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 Detection

Detalhes bibliográficos
Autor(a) principal: Gomes, Fábio
Data de Publicação: 2024
Outros Autores: Lima, Cláudia, Valente, Cristina, Vaz, João, Correia, Lurdes, Correia, Inês
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://doi.org/10.46531/sinapse/CC/230058/2023
Resumo: There have been multiple reports of COVID-19 associated neurological symp-toms, including several cases of para-infectious myelitis.We report a case of an 84-year-old male patient presenting with acute paraparesis coinciding with active mild COVID-19 pneumonia. Spinal cord magnetic resonance imaging (MRI) showed longitudinally extensive transverse myelitis (LETM) affecting the entire cervical cord to the tenth thoracic level, and cerebral spinal fluid (CSF) was positive for SARS-CoV-2. The patient was evaluated for other causes of LETM, which were convincingly excluded. He was treated with steroid pulses and plasmapheresis, with significant imaging improvement. The patient has since made a good recovery, being now able to walk unassisted. Although several instances of COVID-19 associated myelitis have been reported, positive identification of the virus in CSF is rare. The identification of viral material may support the hypothesis of direct spinal cord infection in co-occurrence with a para-infectious inflammatory reaction.
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spelling COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 DetectionMielite Transversa Longitudinalmente Extensa Associada a COVID-19 com Deteção de SARS-CoV-2 no Líquido CefalorraquidianoCOVID-19Myelitis, TransverseRNA, Viral/cerebrospinal fluidSARS-CoV-2COVID-19SARS-CoV-2Mielite TransversaRNA, Viral/líquido cefalorraquidianoThere have been multiple reports of COVID-19 associated neurological symp-toms, including several cases of para-infectious myelitis.We report a case of an 84-year-old male patient presenting with acute paraparesis coinciding with active mild COVID-19 pneumonia. Spinal cord magnetic resonance imaging (MRI) showed longitudinally extensive transverse myelitis (LETM) affecting the entire cervical cord to the tenth thoracic level, and cerebral spinal fluid (CSF) was positive for SARS-CoV-2. The patient was evaluated for other causes of LETM, which were convincingly excluded. He was treated with steroid pulses and plasmapheresis, with significant imaging improvement. The patient has since made a good recovery, being now able to walk unassisted. Although several instances of COVID-19 associated myelitis have been reported, positive identification of the virus in CSF is rare. The identification of viral material may support the hypothesis of direct spinal cord infection in co-occurrence with a para-infectious inflammatory reaction.Têm-se registado múltiplos relatos de sintomas neurológicos associados à CO-VID-19, incluindo vários casos de mielite para-infecciosa. Relatamos o caso de um doente do sexo masculino, de 84 anos de idade, que apresentou um quadro de paraparésia aguda simultaneamente a uma pneumonia ligeira por COVID-19. A res-sonância magnética da medula espinhal revelou uma mielite transversa longitudinal-mente extensa (LETM) com atingimento de toda a medula cervical até ao décimo nível torácico, e com deteção de SARS-CoV-2 no líquido cefalorraquidiano (LCR). O doente foi avaliado para outras possíveis causas de LETM, que foram excluídas de forma convincente. Foi tratado com pulsos de corticoterapia e plasmaferese, com melhoria significativa a nível imagiológico. Desde então, o doente tem tido uma boa recuperação, sendo agora capaz de caminhar sem ajuda. Conclusões: Embora tenham sido relatados vários casos de mielite associada à COVID-19, a identifica-ção positiva do vírus no LCR é rara. A identificação de material viral pode apoiar a hipótese de infeção direta da medula espinhal em simultâneo com uma reação inflamatória para-infecciosa.Portuguese Society of Neurology2024-01-27info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.46531/sinapse/CC/230058/2023https://doi.org/10.46531/sinapse/CC/230058/2023Sinapse; Vol. 23 No. 4 (2023): October - December; 212-216Sinapse; Vol. 23 N.º 4 (2023): Outubro - Dezembro; 212-2162184-42401645-281Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://sinapse.pt/index.php/journal/article/view/6https://sinapse.pt/index.php/journal/article/view/6/6Copyright (c) 2024 Fábio Gomes, Cláudia Lima, Cristina Valente, João Vaz, Lurdes Correia, Inês Correiainfo:eu-repo/semantics/openAccessGomes, FábioLima, CláudiaValente, CristinaVaz, JoãoCorreia, LurdesCorreia, Inês2024-04-30T10:08:44Zoai:sinapse.pt:article/6Portal AgregadorONGhttps://www.rcaap.pt/oai/openairemluisa.alvim@gmail.comopendoar:71602024-04-30T10:08:44Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 Detection
Mielite Transversa Longitudinalmente Extensa Associada a COVID-19 com Deteção de SARS-CoV-2 no Líquido Cefalorraquidiano
title COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 Detection
spellingShingle COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 Detection
Gomes, Fábio
COVID-19
Myelitis, Transverse
RNA, Viral/cerebrospinal fluid
SARS-CoV-2
COVID-19
SARS-CoV-2
Mielite Transversa
RNA, Viral/líquido cefalorraquidiano
title_short COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 Detection
title_full COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 Detection
title_fullStr COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 Detection
title_full_unstemmed COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 Detection
title_sort COVID-19 Associated Longitudinal Extensive Transverse Myelitis with Cerebral Spinal Fluid SARS-CoV-2 Detection
author Gomes, Fábio
author_facet Gomes, Fábio
Lima, Cláudia
Valente, Cristina
Vaz, João
Correia, Lurdes
Correia, Inês
author_role author
author2 Lima, Cláudia
Valente, Cristina
Vaz, João
Correia, Lurdes
Correia, Inês
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Gomes, Fábio
Lima, Cláudia
Valente, Cristina
Vaz, João
Correia, Lurdes
Correia, Inês
dc.subject.por.fl_str_mv COVID-19
Myelitis, Transverse
RNA, Viral/cerebrospinal fluid
SARS-CoV-2
COVID-19
SARS-CoV-2
Mielite Transversa
RNA, Viral/líquido cefalorraquidiano
topic COVID-19
Myelitis, Transverse
RNA, Viral/cerebrospinal fluid
SARS-CoV-2
COVID-19
SARS-CoV-2
Mielite Transversa
RNA, Viral/líquido cefalorraquidiano
description There have been multiple reports of COVID-19 associated neurological symp-toms, including several cases of para-infectious myelitis.We report a case of an 84-year-old male patient presenting with acute paraparesis coinciding with active mild COVID-19 pneumonia. Spinal cord magnetic resonance imaging (MRI) showed longitudinally extensive transverse myelitis (LETM) affecting the entire cervical cord to the tenth thoracic level, and cerebral spinal fluid (CSF) was positive for SARS-CoV-2. The patient was evaluated for other causes of LETM, which were convincingly excluded. He was treated with steroid pulses and plasmapheresis, with significant imaging improvement. The patient has since made a good recovery, being now able to walk unassisted. Although several instances of COVID-19 associated myelitis have been reported, positive identification of the virus in CSF is rare. The identification of viral material may support the hypothesis of direct spinal cord infection in co-occurrence with a para-infectious inflammatory reaction.
publishDate 2024
dc.date.none.fl_str_mv 2024-01-27
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://doi.org/10.46531/sinapse/CC/230058/2023
https://doi.org/10.46531/sinapse/CC/230058/2023
url https://doi.org/10.46531/sinapse/CC/230058/2023
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv https://sinapse.pt/index.php/journal/article/view/6
https://sinapse.pt/index.php/journal/article/view/6/6
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Portuguese Society of Neurology
publisher.none.fl_str_mv Portuguese Society of Neurology
dc.source.none.fl_str_mv Sinapse; Vol. 23 No. 4 (2023): October - December; 212-216
Sinapse; Vol. 23 N.º 4 (2023): Outubro - Dezembro; 212-216
2184-4240
1645-281X
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
repository.mail.fl_str_mv mluisa.alvim@gmail.com
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