COVID-19 associated myelitis: early insights from a multi-center study

ABSTRACT

Introduction: Neurologic complications of Coronavirus Infectious Disease 2019 (COVID-19) are well recognized and may affect both the central and peripheral nervous system.Cases of acute myelitis in close temporal relationship withCOVID-19 are increasingly reported in the literature but may underly a reporting bias. Aim(s) This study aimed to provide insights into acute myelitis associated with COVID-19 by analyzing cases treated at four tertiary care neurology centers. Patients and Methods: The retrospective observational study was conducted at the University Hospital Centre Zagreb in Croatia, University Medical Centre Ljubljana in Slovenia, University Clinical Centre of Serbia in Serbia, and Landesklinikum Mistelbach- Ganserndorf in Austria.We searched foracute myelitis cases that occurred during or after COVID-19. Demographic data, clinical course, magnetic resonance imaging (MRI) findings, cerebrospinal fluid (CSF) analysis, treatment, and outcome were analyzed. Result(s) We identified ten patients (70% male). The mean age was 49.2 years (standard deviation 17.9). In five patients COVID- 19 presented with upper respiratory symptoms. Five patients suffered from COVID-19 pneumonia, but none required mechanical ventilation. Neurological disturbances caused by acute myelitis occurred after a median of 13 days (range 5 to 76 days following the onset of systemic or respiratory COVID-19 symptoms. Spinal cord lesions were identified in eight patients on MRI. CSF examination was performed in eight patients and oligoclonal bands were detected in one patient. Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies were present in one patient. Eight patients were treated with corticosteroids, and three of them received intravenous immunoglobulins. One patient received mycophenolate mofetil. The outcome was good, with partial or complete recovery in nine patients and only one patient experiencing no significant improvement. Conclusion(s) Our study raises awareness for this potential neurological complication of COVID-19. While the time lag of COVID-19 and clinical signs of myelitis point at either post- or parainfectious mechanisms, causality needs to be corroborated. Moreover, further studies need to define the diagnostic approach and clarify the optimal standards of care.