SHM Converge Scientific Abstract ePoster Gallery-Spinal Infarct After Covid-19

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This case report describes a previously healthy 38-year-old man who developed spinal cord infarction after severe COVID-19 infection. He initially presented with cough, fatigue, and myalgias shortly after testing positive for COVID-19. In the emergency department, he was found to have diffuse ST-segment changes, severe left ventricular dysfunction with an ejection fraction of 20%, and a pericardial effusion. Because of impending respiratory failure and cardiogenic shock, he was intubated, underwent pericardiocentesis, had an Impella placed, and was later placed on VA ECMO.<br /><br />On hospital day 17, he developed sudden loss of motor and sensory function, as well as reflexes, in both legs below the waist. CT imaging of the head and spine was negative, but MRI of the thoracic and lumbar spine showed spinal cord infarction at multiple levels, including T2 and T11-L1, with ischemic changes at T7-T8 and possible hemorrhagic involvement. Management focused on maintaining high mean arterial pressures while balancing cardiovascular instability and the risk of spinal hemorrhage. Anticoagulation was temporarily withheld until repeat imaging excluded obvious intrathecal bleeding.<br /><br />His course was further complicated by acute kidney injury requiring renal replacement therapy, bilateral deep vein thromboses, and ventilator-associated pneumonia. He eventually improved enough to be decannulated from ECMO, receive a tracheostomy, and transfer to a long-term acute care hospital, then rehabilitation, and finally home. Cardiac function improved to an ejection fraction of 35-40%, but he remained paraplegic with persistent sensory loss to approximately the L1-L2 level.<br /><br />The authors note that spinal cord infarction is rare and may occur due to surgery, hypercoagulability, shock, or ECMO. COVID-19 may contribute through inflammatory, neuroinvasive, and prothrombotic mechanisms. This case adds to limited reports of COVID-associated spinal cord infarction and highlights the need to consider this diagnosis in patients with new neurologic deficits.

Asset Subtitle

Romi Xi

Meta Tag

Author List Chirag A. Patel, Romi Xi

Category Clinical Vignettes

Concept COVID-19

Concept Spinal Cord Infarction

Concept Thrombosis

Concept Lower-Extremity Motor Function

Concept Lower-Extremity Sensory Function

Distinguished Non-Finalist

Presenter Organization The Ohio State University Wexner Medical Center

Presenting Author Romi Xi

Track Adult

Keywords

COVID-19

spinal cord infarction

paraplegia

VA ECMO

cardiogenic shock

myocardial dysfunction

pericardial effusion

MRI spine

hypercoagulability

thrombotic complications

COVID-19

Spinal Cord Infarction

Thrombosis

Lower-Extremity Motor Function

Lower-Extremity Sensory Function