Spinal cord infarction in a 41-year-old male patient with COVID-19

Abstract

The severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) pandemic, became rapidly recognised by variable phonotypic expressions that involve most major body organs. Neurological complications of severe acute respiratory syndrome coronavirus disease are increasingly encountered in patients with COVID-19 infection, more frequently in patients with severe infection, and develop as a consequence of the neurotropic potential of this virus, secondary cytokine storm and acquired syndrome of COVID-19 coagulopathy. Spinal cord involvement after COVID-19 more commonly includes infectious transverse myelitis, para and post infection myelopathy and, rarely, spinal cord ischaemia related to increased coagulopathy with thromboembolic consequences. We herein report a COVID-19-positive patient with increased coagulopathy and vertebral artery thrombosis leading to posterior circulation and subsequent spinal cord infarction.

Keywords: COVID-19; spinal cord, ischaemia.

Figure 1.

(a) Axial diffusion-weighted imaging b 1000 showing diffuse right cerebellar and right lateral medulla oblongata bright signal intensity (SI); and (b) Corresponding ADC map low SI (long and short arrows, respectively) denoting diffusion restriction due to recent subacute right-sided posterior circulation stroke; (c) Cranial magnetic resonance angiography showing complete occlusion of the intracranial segment of the right vertebral artery with retrograde flow from the contralateral side filling its distal aspect, note bilateral middle cerebral arteries mural irregularities (long and short arrows, respectively). b value: degree of diffusion weighted image applied; ADC: Apparent diffusion coefficient.

Figure 2.

Sagittal magnetic resonance imaging (MRI) of the spinal cord; (a) T2-weighted imaging showing diffuse intermediary bright signal intensity and mild swelling involving cervical and upper dorsal levels of the spinal cord; (b) diffusion-weighted imaging (DWI) b 800; and (c) ADC map showing spinal cord recent ischaemic changes (diffusion restriction) with intramedullary bright and low signal intensity, respectively, involving dorsal D1 to D3 levels (arrows in (a), (b) and (c)). Axial MRI of the spinal cord at the C2 cervical level (d); lower cervical C6 level (e); and upper dorsal T2 level (f); showing variable ischaemic changes at these levels, with unilateral involvement of right anterior deep grey matter at C2, ‘owl eye’ appearance due to symmetric involvement of deep grey matter at C6, and more diffuse involvement of central grey matter and anterior white matter at the T2 level (arrows in (d), (e) and (f)), note loss of signal void in thrombosed right vertebral artery in the right transverse foramen (long arrow in (e)). b value: degree of diffusion weighted image applied; ADC: Apparent diffusion coefficient.