Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection is not confined to the respiratory system, but has also shown extra-pulmonary invasion including the nervous system. About 36.4% of hospitalized patients in China with confirmed coronavirus disease 2019 (COVID-19) infection had neurological manifestations. SARS-CoV-2 virus enters the human body through angiotensin converting enzyme-2 (ACE-2) receptors on the surface of human cells and causes disease. ACE2 receptors are also expressed on the surface of spinal cord cells. More rare neurologic conditions have been reported in the literature to be associated with COVID-19 such as acute transverse myelitis (ATM), Guillain Barre syndrome, acute flaccid myelitis, etc. We report two cases of confirmed COVID-19 who presented four to five days of their COVID-19 symptoms and progressive bilateral lower limb weakness and urinary retention.ATM is an acquired spinal cord disorder. ATM is a relatively common neurological complication of COVID-19, accounting for 1.2% of all neurological complications associated with COVID-19. The mechanism by which COVID-19 causes ATM is not completely understood but has been assumed to be due to the structural resemblance of RNA viruses. Entrance of SARS-CoV-2 to the nervous system can take place through two pathways, either directly or indirectly. The direct pathway is through trans-synaptic transmission from the peripheral nervous system or by hematogenous spread into the blood-brain barrier through ACE-2, while the indirect pathway is through a systemic immune response.
Highlights
Since the revelation of coronavirus disease 2019 (COVID-19) globally from Wuhan, China, the infection has progressively evolved in presentation
We know that the viral infection is not confined to the respiratory system, through which it is transmitted, but has shown extra-pulmonary invasion including the nervous system at different stages of the infection course
We present peculiar neurological complications of COVID-19-related acute transverse myelitis (ATM) in patients who were admitted to the COVID-19 facility, Tertiary Care Hospital, Hamad Medical Cooperation in Doha, Qatar
Summary
Since the revelation of coronavirus disease 2019 (COVID-19) globally from Wuhan, China, the infection has progressively evolved in presentation. About 36.4% of hospitalized patients in China with confirmed COVID-19 infection had neurological manifestations [1]. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus enters the human body through angiotensin converting enzyme-2 (ACE-2) receptors on the surface of human cells and causes disease [2,3]. ACE2 receptors are expressed on the surface of spinal cord cells; whether spinal cord neurons are concerned in COVID-19 is still unknown [4,5]. A spectrum of neuroimaging abnormalities has been described in patients with COVID-19, the most common of which are acute ischemic stroke, cortical FLAIR signal abnormality, cerebral microbleeds, leptomeningeal enhancement, cytotoxic lesions in the splenium of the corpus callosum and other manifestations of encephalitis [6]
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