ABSTRACT
Objective: To describe a case of Anterior Spinal Artery (ASA) syndrome after vaccination -coincidence or causality? Background: As efforts to improve SARS-CoV-2 vaccination continue, more questions safety of the vaccination continues to be raised. Ischemic stroke, intracerebral hemorrhage, and cerebrovascular venous sinus thrombosis have been reported in the literature after COVID -19 mRNA vaccination. Although rare cases of acute transverse myelitis have also been reported, literature regarding post-COVID vaccination ASA syndrome is even rarer. Design/Methods: A 32-year-old female with no significant past medical history presented with acute onset of bilateral extremity weakness and numbness that started 2 weeks ago. Result(s): Patient was awake, alert, and oriented. Physical examination showed decreased tone in wrist bilaterally. Motor examination was normal except for 1/5 handgrip, 2/5 wrist, and 3/5 triceps bilaterally. Triceps and brachioradialis reflexes were absent bilaterally. Sensory examination showed absent pinprick sensations C7 and below. Vibration and proprioception sensations were intact. Patient was recently admitted at outside hospital for same complaint. Neurological work was unremarkable except of an enlarged 4th ventricle for which she underwent left frontal ventriculostomy. Lumbar puncture showed normal IgG index and negative serum NMO Ab. She was treated with IVIG for presumed inflammatory disorder with minimal improvement. Patient underwent a repeat neurological workup at our facility due to ongoing symptoms. EKG showed normal sinus rhythm CT head showed prominent 4th ventricle. CT spine were unremarkable. MRI of the brain showed Postprocedural changes associated with recent prior left trans frontal ventriculostomy catheter. MRI of the cervical and thoracic spine showed T2 hyperintense lesion extending from C3/4 to T1 with central predominance rostrally, whole cord involvement at C5, and with anterior predominance caudally with extent to the upper thoracic level of T1;shows patchy enhancement. TTE was unremarkable. Infectious and hypercoagulable workup was also unremarkable. Patient-reported receiving first dose of Moderna mRNA Covid vaccine 2 weeks prior to onset of symptoms. She was discharged to rehab on aspirin and atorvastatin. Conclusion(s): Our patient presented with symptoms and imaging consistent with ASA syndrome 2/2 infarct of an anterior spinal artery C5-T1. Extensive neurological, infectious, rheumatological, and hypercoagulable workup was negative for etiology. The patient had onset of symptoms after receiving her first dose of mRNA COVID-19 vaccine, however, unclear if the presentation is consistent with postvaccination vaccine ASA syndrome or idiopathic.
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SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Pneumothorax and pneumomediastinum (PTX/PM) has been associated with patients hospitalized with COVID-19 infections. The aim of our study was to assess the risk factors, hospital length of stay, and mortality of PTX/PM among hospitalized patients with COVID-19 infection in a matched case-controlled study. METHODS: Adult patients with confirmed COVID-19 infections who were hospitalized at 5 Mayo Clinic hospitals (Minnesota, Arizona, Florida, Wisconsin) between March 2020 and January 2022 were retrospectively screened. PTX and or PM in at least two consecutive imaging studies were included. They were matched to control patients based on age, gender, hospital admission period, severity on admission day and the day preceding the incident. Summary statistics, Mann Whitney-U, and chi-square tests were performed RESULTS: A total of 197 patients were included in the descriptive analyses.The median age was 61 years and the majority were men (70.8%). Patients with underlying pulmonary comorbidities was 2.27 (OR 1.42-3.62, p value < 0.001) times more likely to develop PTX/PM. Ten percent of the total cases had these complications present upon hospital admission.Patients who developed PTX/PM had a longer hospital length of stay compared to controls, 20 versus 12 days, OR 4.53 (p=0.002). On the day prior to developing PTX/PM, 42 (31%) of patients had been on high-flow nasal cannula only and 14 on non-invasive ventilation (10.4%). The highest recorded positive end-expiratory pressure, plateau, and driving pressures were recorded in our case group on the day before the complication and all were significantly higher than matched controls. In-hospital mortality in patients whose COVID-19 course was complicated by PTX/PM was 44.2% vs. those without, 21.1%, adjusted OR 2.71 (p=0.001). Sixty two percent were treated conservatively without any intervention. CONCLUSIONS: We have demonstrated in the largest study to date, that patients who were hospitalized with COVID-19 infection and had a PTX/PM had a longer hospital length of stay, were associated with higher mechanical ventilatory pressures, and had a higher in-hospital mortality, when compared with matched controls. CLINICAL IMPLICATIONS: Complications of PTX/PM in patients with COVID-19 infections can occur spontaneously and in barotrauma. Pre-existing lung disease is a risk factor for the development of these complications. Patients with PTX/PM have a longer hospital length of stay and higher in-hospital mortality which is in contrast with existing published data. DISCLOSURES: No relevant relationships by Natalya Azadeh No relevant relationships by Meghan Brown No relevant relationships by Rodrigo Cartin-Ceba No relevant relationships by Anusha Devarajan No relevant relationships by Juan Pablo Domecq No relevant relationships by Sandeep Khosa No relevant relationships by Amos Lal No relevant relationships by Shahraz Qamar No relevant relationships by Kenneth Sakata No relevant relationships by Mayank Sharma No relevant relationships by Nikhil Sharma No relevant relationships by Jamil Taji No relevant relationships by Fahimeh Talaei No relevant relationships by Aysun Tekin No relevant relationships by Diana Valencia Morales No relevant relationships by Stephanie Welle
ABSTRACT
A pandemic caused by the novel coronavirus (COVID-19) is causing an unprecedented situation for the world's health services. Health, local communities, and government are adversely affected by the COVID-19 pandemic. Moreover, on January 21, 2020, the WHO Emergency Committee declared a global health emergency because of increasing numbers of COVID-19 case notifications from countries overseas. While the pandemic caused grave damage to socioeconomic phenomena and multiple global phenomena such as commodity prices, remittances, trade, tourism, significant job loss, and drastically lower wages, the pandemic has also negatively affected multiple global phenomena. The advent of technology has spurred significant changes in many aspects of our lives and improved the exchange of information, the presentation of data, and the management of medical resources through telemedicine. In this article, we present a mathematical data visualization approach for analyzing pandemic data behaviors, such as exponential growth and deviations using the data related to COVID-19 events. Furthermore, this article will include studies on the implications of the COVID-19 pandemic on finance sector.