Longitudinal extensive transverse myelitis with sixth nerve palsy post ChAdOx1 nCov-19 vaccine: A case report and literature review

Concurrently with the quick development of COVID-19 vaccines globally, concerns about vaccination efficacy and safety are rising. Neurological complications such as transverse myelitis (TM) are major worries because they can cause lifelong disabilities, which may require long term care. Here, we report a case of longitudinal extensive transverse myelitis (LETM), with sixth nerve palsy in a young female occurring shortly after ChAdOx1 nCov-19 vaccine. The patient recalled developing strabismus, progressive ascending bilateral lower limb weakness, along with upper extremity paresthesia, abnormal sensation below T6 dermatomes, and difficulty in urination. She presented to the hospital with complete paralysis below the neck associated with urinary retention. Extensive diagnostic studies were performed to rule out alternative etiologies, including but not limited to demyelinating diseases, para-post infectious agents, paraneoplastic syndromes, tumors, and autoimmune diseases. She was treated with corticosteroids and discharged upon clinical improvement. However, the patient clinically deteriorated and intravenous immunoglobulin was administered. Unfortunately, the patient is still suffering from physical impairment. We suggested that LETM could be induced by an autoimmune process triggered molecule mimicry. In conclusion, safety monitoring of the COVID-19 vaccines is of great importance in the post marketing surveillance, particularly for rare adverse events.

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Longitudinal extensive transverse myelitis following ChAdOx1 nCOV-19 vaccine: a case report

BMC Neurology ◽

10.1186/s12883-021-02427-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wee Yong Tan ◽

Abdul Hanif Khan Yusof Khan ◽

Mohd Naim Mohd Yaakob ◽

Anna Misyail Abdul Rashid ◽

Wei Chao Loh ◽

...

Keyword(s):

Transverse Myelitis ◽

Neurological Complications ◽

High Dose ◽

Sensory Level ◽

Limb Weakness ◽

Efficacy Trials ◽

First Case ◽

Longitudinal Extensive Transverse Myelitis ◽

Magnetic Resonance Imaging Mri ◽

Extensive Transverse Myelitis

Abstract Background Transverse myelitis (TM) is a relatively uncommon condition, and vaccine-associated myelitis is even rarer. Concern regarding neurological complications following vaccination escalated following the report of TM during the safety and efficacy trials of the COVID-19 vaccine. Case presentation We report the first case of Longitudinal Extensive Transverse Myelitis (LETM) in Malaysia following administration of the chimpanzee adenovirus-vectored (ChAdOx1 nCoV-19) vaccine. A 25-year-old female presented with bilateral lower limb weakness and inability to walk with a sensory level up to T8 with absent visual symptoms. Urgent gadolinium-enhanced magnetic resonance imaging (MRI) of the spine showed long segment TM over the thoracic region. Cerebrospinal fluid autoantibodies for anti-aquaporin-4 and anti-myelin-oligodendrocyte were negative. A diagnosis of LETM following vaccination was made, and the patient was started on a high dose of intravenous methylprednisolone. The patient eventually made a recovery following treatment. Conclusion LETM is a rare but serious adverse reaction following vaccination. Previously reported cases showed an onset of symptoms between 10 to 14 days post-vaccination, suggesting a delayed immunogenic reaction. However, the incidence of myelitis in COVID-19 is much more common, far greater than the risk associated with vaccination.

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Acute longitudinal extensive transverse myelitis secondary to asymptomatic SARS-CoV-2 infection

BMJ Case Reports ◽

10.1136/bcr-2021-244687 ◽

2021 ◽

Vol 14 (7) ◽

pp. e244687

Author(s):

Gabriel Lee

Keyword(s):

Lower Limb ◽

Post Partum ◽

Rare Complication ◽

Transverse Myelitis ◽

Sensory Loss ◽

Nasopharyngeal Swab ◽

Limb Weakness ◽

Lower Limb Weakness ◽

Longitudinal Extensive Transverse Myelitis ◽

Extensive Transverse Myelitis

A 35-year-old woman, 6 months post partum, presented with acute onset back pain at the T8 level progressing to bilateral lower limb weakness and sensory loss with urinary retention and constipation. This patient had a pre-existing inflammatory disease, having recently developed ulcerative colitis antenatally. Five days prior to admission, she had tested positive asymptomatically on a SARS-CoV-2 reverse-transcriptase PCR nasopharyngeal swab. The positive swab result was confirmed on admission. Clinical examination revealed bilaterally exaggerated knee reflexes, lower limb weakness and positive Babinski’s sign. Sensation was impaired at L4 and L5 dermatomes and absent at S1 and S2. MRI findings suggested longitudinal extensive transverse myelitis, with multiple regions of patchy hyperintensity seen in the thoracic region of the spinal cord both centrally and peripherally. She was started on a course of intravenous corticosteroids and improvement was seen both clinically and on repeat imaging. This case demonstrates a rare complication to an asymptomatic COVID-19 infection and explores the potential neurotropic properties of COVID-19.

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Longitudinal Extensive Transverse Myelitis following T-ALL

Neuropediatrics ◽

10.1055/s-0036-1583644 ◽

2016 ◽

Vol 47 (S 01) ◽

Author(s):

V. Kraus ◽

C. Makowski ◽

H. Jünger ◽

A. Wawer ◽

P. Strotmann ◽

...

Keyword(s):

Transverse Myelitis ◽

Longitudinal Extensive Transverse Myelitis ◽

Extensive Transverse Myelitis

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Sixth nerve palsy as the presenting sign of delayed melanoma recurrence

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2021.69 ◽

2021 ◽

pp. 1-8

Author(s):

Arshia Eshtiaghi ◽

Michael TB Nguyen ◽

Jonathan A. Micieli

Keyword(s):

Nerve Palsy ◽

Sixth Nerve Palsy ◽

Sixth Nerve

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Augmented superior rectus muscle transposition in management of defective ocular abduction

BMC Ophthalmology ◽

10.1186/s12886-020-01779-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mohamed F. Farid ◽

Ahmed E. M. Daifalla ◽

Mohamed A. Awwad

Keyword(s):

Nerve Palsy ◽

Rectus Muscle ◽

Muscle Transposition ◽

Primary Position ◽

Superior Rectus ◽

Sixth Nerve Palsy ◽

Abnormal Head ◽

Duane Retraction Syndrome ◽

Sixth Nerve ◽

Superior Rectus Muscle

Abstract Background Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). The aim of the current study is to report the outcomes of augmented SRT in treatment of Eso-DRS and chronic sixth nerve palsy. Methods a retrospective review of medical records of patients with Eso-DRS and complete chronic sixth nerve palsy who were treated by augmented full tendon SRT combined with medial rectus recession (MRc) when intraoperative forced duction test yielded a significant contracture. Effect on primary position esotropia (ET), abnormal head posture (AHP), limitation of ocular ductions as well as complications were reported and analyzed. Results a total of 21 patients were identified: 10 patients with 6th nerve palsy and 11 patients with Eso-DRS. In both groups, SRT was combined with ipsilateral MRc in 18 cases. ET, AHP and limited abduction were improved by means of 33.8PD, 26.5°, and 2.6 units in 6th nerve palsy group and by 31.1PD, 28.6°, and 2 units in Eso-DRS group respectively. Surgical success which was defined as within 10 PD of horizontal orthotropia and within 4 PD of vertical orthotropia was achieved in 15 cases (71.4%). Significant induced hypertropia of more than 4 PD was reported in 3 patients (30%) and in 2 patients (18%) in both groups, respectively. Conclusion augmented SRT with or without MRc is an effective tool for management of ET, AHP and limited abduction secondary to sixth nerve palsy and Eso-DRS. However, this form of augmented superior rectus muscle transposition could result in high rates of induced vertical deviation.

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