University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia.
J Neurol Sci. 2022 Dec 15;443:120463. doi: 10.1016/j.jns.2022.120463. Epub 2022 Oct 27.
We aimed to provide insights into transverse myelitis (TM) following COVID-19 by analyzing cases treated at tertiary care neurology centers and a systemic review of the literature.
The retrospective observational multi-center study was conducted at the four university neurology departments in Croatia, Slovenia, Serbia, and Austria. We searched for acute myelitis cases that occurred during or after COVID-19. A systemic review of the literature on COVID-19 and transverse myelitis was performed.
We identified 76 persons with TM associated with COVID-19, 13 from the multi-center study and 63 from the literature review. Most of the participants (55.6%) had an intermediate latency, 25.4% had short and 19% long latency from COVID-19 symptoms to TM. The clinical presentation consisted of the typical TM signs. More than half of the participants had inflammatory changes in the CSF, with rare patients having intrathecal OCB synthesis and positive serology for anti-MOG or anti-AQP4 antibodies. Persons with autonomic symptoms and CSF pleocytosis were significantly more common to have an intermediate latency of 8 to 21 days from COVID-19 to TM (p = 0.005 and p = 0.003; respectively). According to logistic regression analysis, only participants with lesions evident on spinal cord MRI compared to normal spinal cord MRI had reduced risks for poor recovery. >80% of participants were treated with a combination of corticosteroids and intravenous immunoglobulins or plasma exchange with 73% having incomplete recovery.
Our study further characterizes clinical, laboratory, and MRI features, as well as treatment of TM associated with COVID-19.
我们旨在通过分析在三级护理神经科中心治疗的病例和对文献进行系统回顾，深入了解 COVID-19 后发生的横贯性脊髓炎（TM）。
这项回顾性观察性多中心研究在克罗地亚、斯洛文尼亚、塞尔维亚和奥地利的四个大学神经病学系进行。我们搜索了 COVID-19 期间或之后发生的急性脊髓炎病例。对 COVID-19 和横贯性脊髓炎的文献进行了系统回顾。
我们确定了 76 例与 COVID-19 相关的 TM 病例，其中 13 例来自多中心研究，63 例来自文献综述。大多数参与者（55.6%）潜伏期为中期，25.4%潜伏期较短，19%潜伏期较长，从 COVID-19 症状到 TM。临床表现为典型的 TM 体征。超过一半的参与者脑脊液中有炎症改变，少数患者有鞘内 OCB 合成，以及抗-MOG 或抗-AQP4 抗体的血清学阳性。有自主症状和 CSF 白细胞增多的患者，从 COVID-19 到 TM 的潜伏期明显更长，为 8 至 21 天（p=0.005 和 p=0.003；分别）。根据逻辑回归分析，只有脊髓 MRI 上有病变的参与者与脊髓 MRI 正常的参与者相比，恢复不良的风险降低。>80%的参与者接受了皮质类固醇和静脉注射免疫球蛋白或血浆置换的联合治疗，73%的患者未完全恢复。
我们的研究进一步描述了与 COVID-19 相关的 TM 的临床、实验室和 MRI 特征以及治疗方法。
