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Spastic Paraparesis After SARS-CoV-2 Infection Without Radiological Changes
Sanela Zukic1, Ena Topcic2, Renata Hodzic1
1Department of Neurology, University Clinical Center Tuzla, Tuzla, BIH.
Cureus
|April 14, 2022
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause neurological complications like myelopathy with paraparesis. This case highlights progressive, MRI-negative myelitis following COVID-19, responding well to corticosteroid therapy.
Area of Science:
- Neurology
- Immunology
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, primarily affects the respiratory system.
- However, SARS-CoV-2 can trigger immune-related complications, including neurological disorders like myelopathy with paraparesis.
Observation:
- A 57-year-old female presented with progressive spastic paraparesis and sensory loss after COVID-19.
- Neurological examination revealed spastic paraparesis, brisk reflexes, and a positive Babinski sign.
- Cerebrospinal fluid analysis showed elevated immunoglobulin G (IgG) levels, indicating intrathecal IgG synthesis.
Findings:
- Magnetic resonance imaging (MRI) of the brain and spine showed no abnormalities.
- Serological testing confirmed highly positive IgG and IgM+IgA levels for SARS-CoV-2.
- The patient experienced significant recovery following corticosteroid therapy.
Implications:
- This case underscores the possibility of progressive, MRI-negative myelitis as a neurological complication of SARS-CoV-2 infection.
- The immune-mediated pathogenesis is similar to myelopathies observed in other viral infections like HTLV-1 and HIV-1.
- Early recognition and treatment with corticosteroids can lead to favorable outcomes in post-COVID-19 myelitis.
