Acute myelitis as a neurological complication of Covid-19: A case report and MRI findings

Abstract

During the recent outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 coronavirus, there is rising concerns about neurological complications of COVID-19. Fever, headache, and anosmia may occur early during the disease course. Other neurological sequalae such as encephalitis may occur in later phases. We report a case of acute myelitis in a 32-year old male COVID-19 positive patient who presented with a 2-day history of flu-like symptoms then sudden onset paraplegia and urinary retention. The incidence is not known and the pathogenesis of the disease behind this manifestation is still not fully understood. Nevertheless considering the broad differential diagnosis of acute myelitis, prompt clinical, and diagnostic work up was crucial to exclude other causes. Patients presenting with neurological symptoms such as loss of consciousness, ataxia, convulsions, status epilepticus, encephalitis, myelitis or neuritis should raise concerns for COVID-19 infection during this pandemic prompting early diagnosis and initiation of proper management.

Keywords: Acute Myelitis; Angiotensin Converting Enzyme-2; Covid-19; Magnetic Resonance Imaging; Novel Corona Virus; Pulmonary Embolism.

Fig. 1

Chest X-ray in the frontal view with no evident consolidation or pleural effusion. Cardiothoracic ratio within normal limits.

Fig. 2

A-C: Axial T2 images of the cervical and dorsal spine showing central hyperintense signal of the cervical and dorsal spinal cord at multiple levels. D&E: Sagittal STIR images of the cervical, dorsal and lumbar spine showing hyperintense longitudinal signal involving a long segment of the spinal cord starting at the level of C2.

Fig. 3

A: T1 Gadolinium enhanced MRI of the cervical and upper dorsal spine in sagittal view showing no evidence of abnormal enhancement of the spinal cord. B&C: DWI and ADC sagittal images show evidence of restricted diffusion.

Fig. 4

A&B: Pulmonary CT angiography Maximum Intensity Projection in the right and left oblique views. A. Segmental upper and lower lobe thrombi in the right pulmonary artery. B. Segmental left lower pulmonary artery thrombus C: Coronal lung window images showing clear lungs with no evidence of consolidation or pleural effusion.