新型冠状病毒肺炎感染后急性上升性坏死性脊髓炎：一份临床病理报告
Acute Ascending Necrotizing Myelitis After COVID-19 Infection: A Clinicopathologic Report.
作者信息
Guada Luis, Cabrero Franklyn Rocha, Baldwin Nicole L, Levi Allan D, Gultekin Sakir H, Verma Ashok
机构信息
Departments of Neurology (LG, FRC, NLB, AV), Department of Neurosurgery (ADL), and Department of Pathology (Neuropathology) (SHG), University of Miami Miller School of Medicine, FL.
出版信息
Neurol Clin Pract. 2022 Jun;12(3):e28-e32. doi: 10.1212/CPJ.0000000000001175.
OBJECTIVES
Neurologic manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, COVID-19) infection are common and varied. The objective of this report was to describe clinicopathologic findings of rare acute ascending necrotizing myelitis (ANM) and briefly summarize similar COVID-19-associated longitudinally extended transverse myelitis cases.
METHODS
We described the clinical presentation, disease course, diagnostic workup, therapeutic measures, and pathologic findings of ANM associated with COVID-19 infection.
RESULTS
A 31-year-old previously healthy woman developed a longitudinally extensive lower thoracic myelopathy 3 weeks after COVID-19 infection. The thoracic spinal cord lesion extended to cervical level in 1 week and to the lower medullary level in 2 more weeks. Thoracic laminectomy at T5-T6 level and cord biopsy revealed necrobiotic changes without viral particles or microglial nodules. The clinical deficit stabilized after immunomodulatory and eculizumab therapies.
DISCUSSION
COVID-19 infection can cause ANM. It adds to the spectrum of reported cases of COVID-19 -associated encephalitis and myelitis.
目的
严重急性呼吸综合征冠状病毒2（SARS-CoV-2，新冠病毒）感染的神经系统表现常见且多样。本报告的目的是描述罕见的急性上升性坏死性脊髓炎（ANM）的临床病理特征，并简要总结类似的与新冠病毒相关的纵向扩展型横贯性脊髓炎病例。
方法
我们描述了与新冠病毒感染相关的ANM的临床表现、病程、诊断检查、治疗措施及病理结果。
结果
一名31岁既往健康的女性在感染新冠病毒3周后出现纵向广泛的下胸段脊髓病。胸段脊髓病变在1周内扩展至颈段水平，再过2周扩展至延髓下段水平。在T5 - T6水平进行胸椎椎板切除术及脊髓活检显示有坏死性改变，但未发现病毒颗粒或小胶质结节。在免疫调节治疗及使用依库珠单抗治疗后临床功能缺损稳定。
讨论
新冠病毒感染可导致ANM。这增加了已报道的与新冠病毒相关的脑炎和脊髓炎病例谱。
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