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. 2021 Jun:51:102917.
doi: 10.1016/j.msard.2021.102917. Epub 2021 Mar 21.

COVID-19 and emerging spinal cord complications: A systematic review

Ritwick Mondal  1 , Shramana Deb  2 , Gourav Shome  3 , Upasana Ganguly  1 , Durjoy Lahiri  4 , Julián Benito-León  5
Affiliations

COVID-19 and emerging spinal cord complications: A systematic review

Ritwick Mondal et al. Mult Scler Relat Disord. 2021 Jun.

Abstract

Background: Spinal cord complications associated with coronavirus infectious disease of 2019 (COVID-19) are being widely reported. The purpose of this systematic review was to summarize so far available pieces of evidence documenting de novo novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) mediated spinal cord demyelinating diseases. Indeed, the spinal demyelinating disorders that have been reported in those patients who have suffered from COVID-19 rather than on the people already living with diagnosed or undiagnosed primary demyelinating disorders.

Methods: We used the existing PRISMA consensus statement. Data were collected from PubMed, NIH Litcovid, EMBASE and Cochrane library databases, as well as Pre-print servers (medRxiv, bioRxiv, and pre-preints.org), until September 10, 2020, using pre-specified searching strategies.

Results: The 21 selected articles were all case reports and included 11 (52%) men and 10 (48%) women. The mean age was of 46.7 ± 18.0. The neurological manifestations included weakness, sensory deficit, autonomic dysfunction and ataxia. In most cases, elevated cerebrospinal fluid protein as well as lymphocytic pleocytosis were found. SARS-CoV-2 was detected in five (24%) patients, meanwhile in 13 (62%) patients, the testing was negative. Testing was not performed in two cases and, in one, data were unavailable. Nearly half of the cases (N = 9) were associated with isolated long extensive transverse myelitis (LETM), whereas a combination of both LETM and patchy involvement was found in two. Only five patients had isolated short segment involvement and two patchy involvement. Furthermore, concomitant demyelination of both brain and spine was reported in six patients. Concerning the prognosis, most of the patients improved and the mortality rate was low (N = 2, <10%).

Conclusion: Spinal cord demyelination should be added to the plethora of immune mediated neurologic complications associated with COVID-19.

Keywords: Coronavirus; Covid-19; Demyelinating disorders; Encephalomyelitis; Multiple sclerosis; Sars-cov-2.

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Conflict of interest statement

Declaration of Competing Interest We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We further confirm that any aspect of the work covered in this manuscript that has involved either experimental animals or human patients has been conducted with the ethical approval of all relevant bodies and that such approvals are acknowledged within the manuscript.

Figures

Fig 1
Fig. 1
: flowchart showing the algorithm used to identify the studies included in this review. Flow diagram template was adopted from PRISMA.
See this image and copyright information in PMC

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