MRI negative myelopathy post mild SARS-CoV-2 infection: vasculopathy or inflammatory myelitis?

• DOI: 10.1007/s13365-021-00986-w
• Publication Date: 2021-06-08T15:03:04Z
• Authors: Rory M. C. Abrams; Farinaz Safavi; Stanley Tuhrim; Allison Navis; Jeremy Steinberger; Susan C. Shin
• Keywords: Male; SARS-CoV-2; COVID-19; Case Report; Middle Aged; Magnetic Resonance Imaging; Spinal Cord Diseases; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Humans; Female; Aged

Since the onset of the COVID-19 pandemic, there have been rare reports of spinal cord pathology diagnosed as inflammatory myelopathy and suspected spinal cord ischemia after SARS-CoV-2 infection. Herein, we report five cases of clinical myelopathy and myeloradiculopathy in the setting of post-COVID-19 disease, which were all radiographically negative. Unlike prior reports which typically characterized hospitalized patients with severe COVID-19 disease and critical illness, these patients typically had asymptomatic or mild-moderate COVID-19 disease and lacked radiologic evidence of structural spinal cord abnormality. This case series highlights that COVID-19 associated myelopathy is not rare, requires a high degree of clinical suspicion as imaging markers may be negative, and raises several possible pathophysiologic mechanisms.