Abstract Details

Title Acute Rhomboencephalomyelitis in the setting of COVID-19

Topic Multiple Sclerosis

Presentation(s) MS and CNS Inflammatory Disease Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 012

Objective

To highlight a case of acute rhomboencephalomyelitis related to SARS-CoV-2.

Background We describe a case of rhomboencephalomyelitis in a patient with coronavirus disease 2019, the disease caused by severe acute respiratory syndrome coronavirus 2. There has been increasing attention regarding neurologic sequelae of SARS-CoV-2, including ischemic stroke, seizures, encephalitis, and Guillain-Barre syndrome, but there have been fewer reports of coronavirus-related transverse myelitis. It appears SARS-CoV-2 can cause inflammatory complications in the myelin of the brainstem and spinal cord without other typical coronavirus symptoms.

Design/Methods Clinical case

Results A 36 year old man with no medical history presented with acute urinary retention, bilateral lower extremity weakness and blurry vision and was found to have COVID-19. Neurologic exam was remarkable for paraplegia and multiple cranial nerve palsies. MRI of brain and spine showed T2 hyperintensity in the medulla, patchy leptomeningeal enhancement and abnormal cord signal in the lower thoracic cord and conus. CSF studies demonstrated glucose 45, protein 180, TNC 594 with lymphocytic predominance, myelin basic protein 6.4, and beta-2 microgloblin 5.86, likely related to an underlying lymphoproliferative process. CSF gram stain, culture, viral PCR, oligoclonal bands and flow cytometry were negative. Other negative studies included NMO antibody, MOG antibody, and serum ACE. He was treated with pulse steroids for five days and seven sessions of plasmapheresis. Upon discharge, he was ambulating with a walker with 4/5 strength in the lower extremities. Repeat MRI of brain and spine three months later showed near complete resolution of previously abnormal signal in the medulla, thoracic cord and conus.

Conclusions This patient had acute brainstem and spinal cord dysfunction and abnormal imaging findings in conjunction with COVID-19, consistent with rhomboencephalomylelitis. There is increasing evidence that implicates an enhanced immune response in a wide range of complications from COVID-19.Our patient showed significant neurological improvement after treatment with immune modulating therapy.

Authors/Disclosures
Jordana S. Schneider, DO (Northwell) PRESENTER	Dr. Schneider has nothing to disclose.
Anna Babaie, DO	Dr. Babaie has nothing to disclose.
Santo Terranova, DO (Terranova Medical, PLLC)	Dr. Terranova has nothing to disclose.

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