Introduction
The COVID-19 pandemic has presented numerous challenges for healthcare professionals, with SARS-CoV-2 affecting multiple organ systems, including the nervous system. A recent study, "Two Case Reports of Patients With Transverse Myelitis as a Complication of SARS-CoV-2 Infection," highlights a rare but severe neurological complication: transverse myelitis (TM). This blog aims to provide practitioners with insights on how to improve their skills by understanding the outcomes of this research and encouraging further investigation.
Understanding Transverse Myelitis
Transverse myelitis is a nontraumatic spinal cord injury characterized by sudden onset weakness, sensory deficits, and autonomic dysfunction. It can be caused by various etiologies, including malignancy, autoimmune disorders, infections, and environmental factors. The study presents two cases of elderly male patients who developed TM as a complication of SARS-CoV-2 infection, despite not exhibiting classic symptoms of the virus.
Case Summaries
Case 1
A 68-year-old unvaccinated male presented with acute lower extremity weakness, progressing to complete paraplegia and urinary retention. He tested positive for SARS-CoV-2 and was diagnosed with acute TM. Treatment with intravenous steroids had minimal impact, but therapeutic plasma exchange (TPE) led to significant improvement in muscular strength and neurological function.
Case 2
A 64-year-old unvaccinated male developed TM after experiencing initial symptoms of headaches, fevers, and diarrhea. He also tested positive for SARS-CoV-2. Similar to the first case, intravenous steroids had minimal effect, but TPE resulted in significant improvement in strength and neurological function.
Implications for Practitioners
The study underscores the importance of considering TM as a potential complication of SARS-CoV-2, even in the absence of classic symptoms. Here are some key takeaways for practitioners:
- Early Diagnosis: Be vigilant in recognizing the symptoms of TM, especially in patients with a recent history of SARS-CoV-2 infection. Early diagnosis can significantly impact treatment outcomes.
- Treatment Protocols: While intravenous steroids are the first line of treatment, consider TPE for patients who do not respond adequately to steroids. The study shows that TPE can lead to substantial improvement in neurological function.
- Comprehensive Assessment: A thorough medical, social, and travel history is crucial for diagnosing TM. MRI with gadolinium contrast is the gold standard for diagnosis and helps rule out other etiologies.
- Long-term Management: Physical and occupational therapy play a vital role in the rehabilitation of TM patients. Educate families about the disease course and the need for long-term support and care.
Encouraging Further Research
The cases presented in the study highlight the need for more research to understand the mechanisms by which SARS-CoV-2 can lead to TM. Practitioners are encouraged to contribute to this growing body of knowledge by documenting and sharing their experiences with similar cases.
Conclusion
As the COVID-19 pandemic continues, it is crucial for healthcare professionals to be aware of the diverse presentations of SARS-CoV-2 infection. The study provides valuable insights into the diagnosis and treatment of TM as a complication of the virus. By implementing these findings, practitioners can improve patient outcomes and contribute to the broader understanding of this rare but severe complication.
To read the original research paper, please follow this link: Two Case Reports of Patients With Transverse Myelitis as a Complication of SARS-CoV-2 Infection.
