MRI negative myelopathy post mild SARS-CoV-2 infection: vasculopathy or inflammatory myelitis?

J Neurovirol. 2021 Aug;27(4):650-655. doi: 10.1007/s13365-021-00986-w. Epub 2021 Jun 8.

Abstract

Since the onset of the COVID-19 pandemic, there have been rare reports of spinal cord pathology diagnosed as inflammatory myelopathy and suspected spinal cord ischemia after SARS-CoV-2 infection. Herein, we report five cases of clinical myelopathy and myeloradiculopathy in the setting of post-COVID-19 disease, which were all radiographically negative. Unlike prior reports which typically characterized hospitalized patients with severe COVID-19 disease and critical illness, these patients typically had asymptomatic or mild-moderate COVID-19 disease and lacked radiologic evidence of structural spinal cord abnormality. This case series highlights that COVID-19 associated myelopathy is not rare, requires a high degree of clinical suspicion as imaging markers may be negative, and raises several possible pathophysiologic mechanisms.

Keywords: Inflammatory myelopathy; Ischemic myelopathy; Long Haul Covid; Post Acute Covid-19 Syndrome; Transverse myelopathy syndrome.

Publication types

  • Case Reports
  • Research Support, N.I.H., Intramural

MeSH terms

  • Aged
  • COVID-19 / complications*
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • SARS-CoV-2
  • Spinal Cord Diseases / etiology*
  • Spinal Cord Diseases / pathology*