Transverse myelitis (TM) is a focal disorder of the spinal cord presenting in acute or subacute manner (hours/days) resulting in motor, sensory, and autonomic dysfunction of varying degrees of expression depending on the type, location and surface of the lesion longitudinally and transversely. The term longitudinally extensive transverse myelitis (LETM) is used when the spinal cord lesion extends over three or more vertebral segments.
The possible causes of myelitis are as follows: infections (viruses, bacteria, fungi, parasites), post-infectious or post-vaccination, paraneoplastic, demyelinating (multiple sclerosis (MS), neuromyelitis optica (NMO), acute disseminated encephalomyelitis, other inflammatory disorders (neurosarcoidosis, systemic lupus erythematosus, Sjögren syndrome, Behçet's disease), congestive edema due to dural arterio-venous fistula, and tumor [1, 2]. TM may be idiopathic in 15-30% of cases. Post-infectious and idiopathic myelitis incidence varies between 1.3 - 8 cases / 1 million, but can reach 24.6 cases / million in patients with MS [3]. Recently case reports of myelitis associated with the new coronavirus infection were published, but the mechanism of spinal cord injury remains unclear [4,5].
Human-immunodeficiency virus (HIV) causes spinal cord injury both by direct HIV virus invasion, presenting in vacuolar myelitis in most of cases, as well as a manifestation of opportunistic virus-induced infections (Herpes simplex virus (HSV), Cytomegalovirus (CMV), Epstein-Barr virus (EBV), Varicella Zoster virus, or bacteria (Mycobacterium tuberculosis, Treponema pallidum), but can also be due to vitamin B12 deficiency. Vacuolar myelopathy (VM) is symptomatic in 5-10% of acquired immune deficiency syndrome (AIDS) patients, has a progressive evolution and is pathologically characterized by the presence of intralamellar white matter vacuoles in the posterior and lateral columns of the thoracic spinal cord [6].
SARS-CoV-2 causing the COVID-19 pandemic is proven to be neurotropic and may affect the central and peripheral nervous system. The mechanism of the new type of coronavirus neuroinvasion has not yet been fully identified. [7]. Short- and long-term health effects for patients who have been infected have not yet been assessed. The changes induced by the new type of coronavirus in the coagulation status resulted in an impressive number of fatal thromboembolic events, including the cerebral ones. Guillain-Barré syndrome reported in COVID-positive patients is explained as rather a possible parainfectious manifestation, and cases of necrotizing hemorrhagic meningoencephalitis, altered mental status, and respiratory distress syndrome are referred to both direct virus action on brain neurons, as well as cytokine storm syndrome [8,9].