Acute Spinal Cord Infarction in the Setting of Diabetic Ketoacidosis Status Post COVID-19 Infection: A Case Report

ABSTRACT

Case Diagnosis 37-year-old female with nontraumatic spinal cord injury secondary to spinal stroke. Case Description or Program Description Patient in diabetic ketoacidosis (DKA) 13 days status post COVID-19 infection presented with acute onset back pain, right-sided monoplegia, and neurogenic bladder/ bowel. Workup revealed T-spine MRI with abnormal signal in spinal cord at T8/9 level and T-spine angiogram with partial occlusion of proximal anterior spinal artery (ASA) at T9. Patient had not received any COVID-19 vaccine doses. Setting(s) Acute inpatient rehabilitation hospital Assessment/Results: Patient progressed well with therapy and showed reasonably good return of function for the right lower limb. On admission to acute inpatient rehabilitation, patient required two-person assistance level within the parallel bars to ambulate 6 feet. At time of discharge, patient ambulated 152 feet with a rolling walker at standby assistance level. Patient successfully able to self-catheterize for neurogenic bladder and was started on a bowel program with scheduled suppositories. Discussion (relevance) Spinal cord infarction is a rarely documented complication of both DKA and COVID-19 infection. Multifactorial explanations for this phenomenon include etiology stemming from acute cerebrospinal edema and an increasingly hypercoagulable state. To our knowledge this is the first documented case of acute spinal cord infarction in the post- COVID-19 setting. We hypothesize our patient's spinal infarct may have occurred when her elevated hypercoagulable state following COVID-19 infection was exacerbated by DKA in the presence of proximal ASA occlusion. Conclusion(s) Patients in DKA status post COVID-19 infection experiencing an increased hypercoagulable state may be at risk of acute spinal cord infarction. This phenomenon requires further investigation.