From the Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India (AB, JS, AV, SSR, RS, SB); and Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India (RS).
Am J Phys Med Rehabil. 2021 Oct 1;100(10):919-939. doi: 10.1097/PHM.0000000000001857.
The objective of this review was to analyze the existing data on acute inflammatory myelopathies associated with coronavirus disease 2019 infection, which were reported globally in 2020. PubMed, CENTRAL, MEDLINE, and online publication databases were searched. Thirty-three acute inflammatory myelopathy cases (among them, seven cases had associated brain lesions) associated with coronavirus disease 2019 infection were reported. Demyelinating change was seen in cervical and thoracic regions (27.3% each, separately). Simultaneous involvement of both regions, cervical and thoracic, was seen in 45.4% of the patients. Most acute inflammatory myelopathy disorders reported sensory motor and bowel bladder dysfunctions. On cerebrospinal fluid analysis, pleocytosis and increased protein were reported in 56.7% and 76.7% of the patients, respectively. Cerebrospinal fluid severe acute respiratory syndrome coronavirus 2 reverse transcriptase-polymerase chain reaction was positive in five patients. On T2-weighted imaging, longitudinally extensive transverse myelitis and short-segment demyelinating lesions were reported in 76% and 21%, respectively. Among the patients with longitudinally extensive transverse myelitis, 61% reported "moderate to significant" improvement and 26% demonstrated "no improvement" in the motor function of lower limbs. Demyelinating changes in the entire spinal cord were observed in three patients. Most of the patients with acute inflammatory myelopathy (including brain lesions) were treated with methylprednisolone (81.8%) and plasma-exchange therapy (42.4%). An early treatment, especially with intravenous methylprednisolone with or without immunoglobulin and plasma-exchange therapy, helped improve motor recovery in the patients with acute inflammatory myelopathy associated with coronavirus disease 2019.
本次综述的目的是分析 2020 年全球报道的与 2019 冠状病毒病相关的急性炎症性脊髓病的现有数据。检索了 PubMed、CENTRAL、MEDLINE 和在线出版数据库。报告了 33 例与 2019 冠状病毒病感染相关的急性炎症性脊髓病病例（其中 7 例伴有脑部病变）。颈段和胸段分别有 27.3%（各有）出现脱髓鞘改变。45.4%的患者同时累及颈段和胸段。大多数报告的急性炎症性脊髓病疾病伴有感觉运动和肠膀胱功能障碍。在脑脊液分析中，分别有 56.7%和 76.7%的患者报告有细胞增多症和蛋白增加。5 例患者的脑脊液严重急性呼吸综合征冠状病毒 2 逆转录-聚合酶链反应呈阳性。在 T2 加权成像上，报告 76%的患者存在纵向广泛横贯性脊髓炎，21%的患者存在短节段脱髓鞘病变。在纵向广泛横贯性脊髓炎患者中，61%报告下肢运动功能“中度至显著”改善，26%无改善。3 例患者观察到整个脊髓的脱髓鞘改变。大多数伴有急性炎症性脊髓病（包括脑部病变）的患者接受了甲基强的松龙（81.8%）和血浆置换治疗（42.4%）。早期治疗，尤其是静脉内甲基强的松龙联合或不联合免疫球蛋白和血浆置换治疗，有助于改善与 2019 冠状病毒病相关的急性炎症性脊髓病患者的运动功能恢复。
