Department of Neurology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200336, China.
Institute of Neurology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Neurol Sci. 2024 May;45(5):1835-1843. doi: 10.1007/s10072-024-07351-9. Epub 2024 Mar 2.
We reported four patients with coronavirus disease 2019 (COVID-19)-associated myelopathies, highlighting the delayed and atypical spinal cord magnetic resonance imaging (MRI) features and the literature review. All four patients were males, aged 37 to 72 years old. The latencies from COVID-19 to the onset of myelitis were 5, 15, 30, and 80 days. The initial symptoms were numbness and weakness of lower limbs in three cases, and back pain with weakness of lower limbs in one case. The peak symptoms included paraplegia, sphincter dysfunction, sensory disturbance level, and spastic gait. The EDSS scores were 7.5, 9.0, 9.0, and 7.5, respectively. Magnetic resonance imaging (MRI) showed delayed atypical spinal cord lesions at onset, i.e., two cases without lesions, one with linear spinal meningeal enhancement, and one with punctate lesions on T2-weighted imaging (T2WI). During the follow-up period, punctate, linear, and cloudy lesions in the lateral and posterior funiculus were seen on T2WI in the peak stage. The prominent features of spinal cord lesions were linear spinal meningeal enhancement, the mismatch of deteriorated clinical symptoms, and inapparent MRI findings. All four patients were left with an obvious disability, with two patients completely bedridden and two who could stand with support. This report highlights the recognition of COVID-19-associated myelopathy even months after initial infection, especially in patients with delayed and atypical spinal cord findings on MRI.
我们报道了 4 例与 2019 年冠状病毒病（COVID-19）相关的脊髓病患者，强调了延迟和非典型的脊髓磁共振成像（MRI）特征，并进行了文献复习。这 4 名患者均为男性，年龄 37 至 72 岁。从 COVID-19 到脊髓炎发病的潜伏期为 5、15、30 和 80 天。最初的症状是 3 例下肢麻木无力，1 例下肢疼痛伴无力。高峰症状包括截瘫、括约肌功能障碍、感觉障碍水平和痉挛步态。EDSS 评分分别为 7.5、9.0、9.0 和 7.5。磁共振成像（MRI）显示起病时出现延迟的非典型脊髓病变，即 2 例无病变，1 例线性脊髓脑膜强化，1 例 T2 加权成像（T2WI）上呈点状病变。在随访期间，在高峰阶段，T2WI 上可见侧索和后索的点状、线性和云状病变。脊髓病变的突出特征是线性脊髓脑膜强化、临床症状恶化与 MRI 表现不相符。这 4 例患者均遗留明显残疾，2 例完全卧床不起，2 例需支撑站立。本报告强调了即使在初始感染数月后，也要认识到 COVID-19 相关的脊髓病，尤其是在 MRI 上出现延迟和非典型脊髓表现的患者。
