PDF(Pubmed)
Abstract：
We reported four patients with coronavirus disease 2019 (COVID-19)-associated myelopathies, highlighting the delayed and atypical spinal cord magnetic resonance imaging (MRI) features and the literature review. All four patients were males, aged 37 to 72 years old. The latencies from COVID-19 to the onset of myelitis were 5, 15, 30, and 80 days. The initial symptoms were numbness and weakness of lower limbs in three cases, and back pain with weakness of lower limbs in one case. The peak symptoms included paraplegia, sphincter dysfunction, sensory disturbance level, and spastic gait. The EDSS scores were 7.5, 9.0, 9.0, and 7.5, respectively. Magnetic resonance imaging (MRI) showed delayed atypical spinal cord lesions at onset, i.e., two cases without lesions, one with linear spinal meningeal enhancement, and one with punctate lesions on T2-weighted imaging (T2WI). During the follow-up period, punctate, linear, and cloudy lesions in the lateral and posterior funiculus were seen on T2WI in the peak stage. The prominent features of spinal cord lesions were linear spinal meningeal enhancement, the mismatch of deteriorated clinical symptoms, and inapparent MRI findings. All four patients were left with an obvious disability, with two patients completely bedridden and two who could stand with support. This report highlights the recognition of COVID-19-associated myelopathy even months after initial infection, especially in patients with delayed and atypical spinal cord findings on MRI.
摘要：
我们报道了四名2019年冠状病毒病（COVID-19）相关的脊髓病患者，突出延迟和不典型的脊髓磁共振成像（MRI）特征并进行文献复习。四名患者均为男性,37至72岁。从COVID-19到脊髓炎发作的潜伏期为5、15、30和80天。3例首发症状为下肢麻木无力,在一例中，背痛伴下肢无力。高峰症状包括截瘫,括约肌功能障碍,感觉障碍水平,痉挛步态.EDSS评分分别为7.5、9.0、9.0和7.5。磁共振成像（MRI）显示发病时延迟的非典型脊髓病变，即，2例无病变,一个有线性脊髓脑膜增强，和一个在T2加权成像（T2WI）上有点状病变。在后续期间,点状,线性,在高峰期的T2WI上可见外侧和后部真菌的混浊病变。脊髓病变的突出特征是线性脊髓脑膜强化，恶化的临床症状不匹配，和不明显的MRI发现。所有四名患者都有明显的残疾，两名患者完全卧床不起，两名患者可以支持。这份报告强调了对COVID-19相关性脊髓病的认识，甚至在初次感染后几个月，尤其是在MRI上有延迟和不典型脊髓发现的患者中。
