Durrani Muhammad, Kucharski Kevin, Smith Zachary, Fien Stephanie
Inspira Medical Center, Department of Emergency Medicine, Vineland, New Jersey.
Clin Pract Cases Emerg Med. 2020 Aug;4(3):344-348. doi: 10.5811/cpcem.2020.6.48462.
Respiratory viral illnesses are associated with diverse neurological complications, including acute transverse myelitis (ATM). Among the respiratory viral pathogens, the Coronaviridae family and its genera coronaviruses have been implicated as having neurotropic and neuroinvasive capabilities in human hosts. Despite previous strains of coronaviruses exhibiting neurotropic and neuroinvasive capabilities, little is known about the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its involvement with the central nervous system (CNS). The current pandemic has highlighted the diverse clinical presentation of SARS-CoV-2 including a possible link to CNS manifestation with disease processes such as Guillain-Barré syndrome and cerebrovascular disease. It is critical to shed light on the varied neurological manifestation of SARS-CoV-2 to ensure clinicians do not overlook at-risk patient populations and are able to provide targeted therapies appropriately.
While there are currently no published reports on post-infectious ATM secondary to SARS-CoV-2, there is one report of parainfectious ATM attributed to SARS-CoV-2 in pre-print. Here, we present a case of infectious ATM attributed to SARS-CoV-2 in a 24-year-old male who presented with bilateral lower-extremity weakness and overflow urinary incontinence after confirmed SARS-CoV-2 infection. Magnetic resonance imaging revealed non-enhancing T2-weighted hyperintense signal abnormalities spanning from the seventh through the twelfth thoracic level consistent with acute myelitis.
The patient underwent further workup and treatment with intravenous corticosteroids with improvement of symptoms and a discharge diagnosis of ATM secondary to SARS-CoV-2.
呼吸道病毒性疾病与多种神经系统并发症相关，包括急性横贯性脊髓炎（ATM）。在呼吸道病毒病原体中，冠状病毒科及其属的冠状病毒被认为在人类宿主中具有嗜神经和神经侵袭能力。尽管先前的冠状病毒株表现出嗜神经和神经侵袭能力，但对于新型严重急性呼吸综合征冠状病毒2（SARS-CoV-2）及其与中枢神经系统（CNS）的关系知之甚少。当前的大流行突出了SARS-CoV-2的多种临床表现，包括与吉兰-巴雷综合征和脑血管疾病等疾病过程导致的中枢神经系统表现可能存在的联系。阐明SARS-CoV-2的各种神经学表现至关重要，以确保临床医生不会忽视高危患者群体，并能够适当地提供针对性治疗。
虽然目前尚无关于SARS-CoV-2继发感染后ATM的已发表报告，但有一份预印本报告称SARS-CoV-2导致了感染后ATM。在此，我们报告一例24岁男性因SARS-CoV-2感染导致的感染性ATM病例，该患者在确诊SARS-CoV-2感染后出现双侧下肢无力和充溢性尿失禁。磁共振成像显示，从胸7至胸12水平有非强化的T2加权高信号异常，符合急性脊髓炎表现。
患者接受了进一步检查，并接受静脉注射皮质类固醇治疗，症状有所改善，出院诊断为SARS-CoV-2继发的ATM。
