Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2023; 11(36): 8542-8550
Published online Dec 26, 2023. doi: 10.12998/wjcc.v11.i36.8542
Spinal cord infarction attributed to SARS-CoV-2, with post-acute sequelae of COVID-19: A case report
Christina V Oleson, Andrew C Olsen, Suzanna Shermon
Christina V Oleson, Andrew C Olsen, Suzanna Shermon, Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Rehabilitation Institute, Cleveland, OH 44109, United States
Author contributions: Oleson CV was responsible for concept design, for the great majority of the writing of this manuscript, and for creation of Table 1 and 3; Oleson CV was also responsible for portions of data extraction; Olsen AC was responsible for background information and literature review, consent of the participant, and portions of the written manuscript. He was also responsible for image extraction and translation to jpg format and for Table 2; Shermon S was responsible for background information, a literature review and formatting of the manuscript including footnotes, tables and references.
Informed consent statement: Written consent using IRB approved forms for publication of case reports were obtained from the participant.
Conflict-of-interest statement: The authors have no conflict of interests that would be relevant for this publication to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christina V Oleson, MD, Professor, Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Rehabilitation Institute, 4229 Pearl Road 2 North, Room 17, Cleveland, OH 44109, United States. coleson@metrohealth.org
Received: September 8, 2023
Peer-review started: September 8, 2023
First decision: November 9, 2023
Revised: November 29, 2023
Accepted: December 12, 2023
Article in press: December 12, 2023
Published online: December 26, 2023
Abstract
BACKGROUND

While stroke and lower extremity venous thromboemboli have been commonly reported following acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spinal cord infarction or ischemia has been extremely rare. Findings of long coronavirus disease (COVID) in this select population have not been studied.

CASE SUMMARY

We present the case of a 70-year-old female with sudden onset of trunk and lower extremity sensorimotor loss due to spinal cord infarction, attributed to acute infection with SARS-CoV-2. Diagnostic work up confirmed a T3 complete (ASIA impairment Scale A) paraplegia resulting from a thrombotic infarct. Her reported myalgias, neuropathic pain, spasticity, bladder spasms, and urinary tract infections exceeded the frequency and severity of many spinal cord injury (SCI) individuals of similar age and degree of neurologic impairment. In her first year after contracting COVID-19, she underwent 2 separate inpatient rehabilitation courses, but also required acute hospitalization 6 additional times for subsequent infections or uncontrolled pain. Yet other complications of complete non-traumatic SCI (NTSCI), including neurogenic bowel and temperature hypersensitivity, were mild, and pressure injuries were absent. She has now transitioned from the acute to chronic phase of spinal cord injury care, with subsequent development of post-acute sequelae of SARS-CoV-2 infection (PASC).

CONCLUSION

This individual experienced significant challenges with the combined effects of acute T3 NTSCI and acute COVID-19, with subsequent progression to PASC.

Keywords: Spinal cord infarction, Paraplegia, COVID-19, SARS-CoV-2, Post-acute sequelae of SARS-CoV-2 infection, Long COVID, Case report

Core Tip: Although stroke and venous thromboembolism have been frequently observed with acute coronavirus disease 2019 (COVID-19), spinal cord infarction leading to paraplegia has rarely been seen. We report a case of spinal cord infarction shortly following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Consequently, this individual has experienced severe neurologic disability, with subsequent development of long COVID. Symptoms such as myalgias, neuropathic pain, muscle spasms, and frequent bacterial infections are present in post-acute sequelae of SARS-CoV-2 infection (PASC), independent of spinal cord injury (SCI). Over the past 3 years, the dual presence of PASC and recent SCI may have led to increased severity of symptoms shared by both conditions.