Clinical features, laboratory and radiological findings of patients with acute inflammatory myelopathy following COVID-19 infection: a narrative review.

ABSTRACT: The objective of this review is to analyze the existing data on acute inflammatory myelopathies (AIM) associated with COVID-19 infection, which were reported globally in 2020. PubMed, CENTRAL, MEDLINE, and online publication databases were searched. Thirty-three AIM cases (among them, seven cases had associated brain lesions) associated with COVID-19 infection were reported. Demyelinating-change was seen in cervical and thoracic regions (27.3% each, separately). Simultaneous involvement of both regions, cervical and thoracic, was seen in 45.4% patients. Most AIM disorders reported sensory-motor and bowel-bladder dysfunctions. On cerebrospinal fluid (CSF) analysis, pleocytosis and increased protein were reported in 56.7% and 76.7% of patients, respectively. CSF SARS-CoV-2 RT-PCR was positive in five patients. On T2-weighted imaging, longitudinally extensive transverse myelitis (LETM) and short-segment demyelinating lesions were reported in 76% and 21%, respectively. Among patients with LETM, 61% reported "moderate to significant" improvement, and 26% demonstrated "no improvement" in the motor-function of lower-limbs. Demyelinating-changes in entire spinal cord were observed in 3 patients. Most of the patients with AIM (including brain lesions) were treated with methylprednisolone (81.8%) and plasma-exchange therapy (42.4%). An early treatment, especially with IV-methylprednisolone with or without immunoglobulin and plasma-exchange therapy, helped improve motor-recovery in patients with AIM associated with COVID-19.