ABSTRACT
Hemorrhage in the setting of myelitis is rarely seen in clinical practice. We report a series of three women aged 26, 43, and 44 years-old, who presented with acute hemorrhagic myelitis within 4 weeks of SARS-CoV-2 infection. Two required intensive care and one had severe disease with multi-organ failure. Serial magnetic resonance imaging (MRI) of the spine demonstrated T2-weighted hyperintensity with T1-weighted post-contrast enhancement in the medulla and cervical spine (patient 1), and thoracic spine (patients 2 and 3). Hemorrhage was identified on pre-contrast T1-weighted, susceptibility weighted and gradient echo sequences. Distinct from typical inflammatory or demyelinating myelitis, clinical recovery was poor in all cases, with residual quadriplegia or paraplegia, despite immunosuppression. These cases highlight that although hemorrhagic myelitis is rare, it can occur as a post/para-infectious complication of SARS-CoV-2 infection.
ABSTRACT
BACKGROUND: Multiple sclerosis (MS) with onset in the setting of acute SARS-CoV-2 virus infection has been reported, and reactivation of MS following non-mRNA COVID-19 vaccination has been noted, but there have only been three reports of newly diagnosed MS following exposure to mRNA COVID-19 vaccine. The association cannot be determined to be causal, as latent central nervous system demyelinating disease may unmask itself in the setting of an infection or a systemic inflammatory response. We report a series of 5 cases of newly diagnosed MS following recent exposure to mRNA COVID-19 vaccines. Latency from vaccination to initial presentation varied. Neurological manifestations and clinical course appeared to be typical for MS including response to high dose steroids in 4 cases and additional need for plasmapheresis in one case. CONCLUSION: Acute neurological deficits in the setting of recent mRNA COVID-19 vaccine administration may represent new onset multiple sclerosis.