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Sourani A, Vahdat N, Bowers CA, Rezvani M, Foroughi M, Sourani A, Mirza R, Baradaran Mahdavi S. SARS-CoV-2 and spinal cord ischemia: a systematic review on clinical presentations, diagnosis, treatment, and outcomes. Spine J 2024; 24:979-988. [PMID: 38365009 DOI: 10.1016/j.spinee.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/16/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND CONTEXT Spinal cord ischemia is a rare but ominous clinical situation with high levels of disability. There are emerging reports on COVID-19 and spinal cord ischemic events. PURPOSE To investigate the cardinal manifestations of SARS-CoV-2 associated spinal cord ischemia, review treatment paradigms, and follow outcomes. STUDY DESIGN A systematic review. METHODS The current study was conducted under Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The authors searched PubMed, Scopus, Web of Science, and Google Scholar for studies published up to February 12, 2023, on spinal cord ischemia and SARS-CoV-2 infection. Data on patient demographics, study methods, medical records, interventions, and outcomes were extracted from eligible articles. For each data set, the authors performed pooled estimates examining 3 factors of interest, which were (1) predisposing factors (2) treatment regimens, and (3) neurological rehabilitation outcomes. Neurological status was reported as the American Spinal Injury Association (ASIA) impairment scale reported by data sets. RESULTS Six data sets were identified. The mean age of the study population was 50 years old, with 66.6% male predominance. Sixty-six percent of the patients had severe COVID-19. Five data sets reported preexisting coagulopathy. ASIA A and B were the most prevalent primary neurological status (80%). The mean interval between COVID-19 and the first neurological deficit was 13 days. Anterior spinal artery lesions were the most prevalent ischemic pattern. The most common treatment regimens were heparin and steroid therapy. Physical rehabilitation showed poor functional outcomes. CONCLUSIONS SARS-CoV-2 is associated with spinal cord ischemia through multiple neuropathological mechanisms. Proper coagulation profile control and aggressive rehabilitation may play a promising role in the prevention and recovery of spinal cord infarction in SARS-CoV-2 patients.
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Affiliation(s)
- Arman Sourani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran; Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Vahdat
- Department of Radiology, University of California San Diego (UCSD), San Diego, CA, USA; Department of Radiology, Veterans Administration Healthcare System, San Diego, CA, USA
| | - Christian A Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA; Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, 87131, USA
| | - Majid Rezvani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mina Foroughi
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Armin Sourani
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ryan Mirza
- Department of Radiology, University of California San Diego (UCSD), San Diego, CA, USA
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
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Rezvani M, Mahmoodkhani M, Sourani A, Sharafi M, Foroughi M, Baradaran Mahdavi S, Sourani A, Nik Khah R, Veisi S. Treatment refractory acute necrotizing myelitis after COVID-19 vaccine injection: a case report. Ann Med Surg (Lond) 2024; 86:1185-1190. [PMID: 38333280 PMCID: PMC10849463 DOI: 10.1097/ms9.0000000000001662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/15/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Post-vaccination myelitis is a rare and debilitating clinical situation. There are few reports of post-COVID-19 infection and vaccination neurological sequela. Case presentation A 69-year-old lady was admitted to the emergency department due to weakness and hypoesthesia in her hands 1 week after the Sinopharm vaccine injection. MRI showed a cervicothoracic cord haemorrhagic lesion that deteriorated within 48 h. The clinical course was refractory to conservative treatments. She underwent an emergency cervical laminectomy as a salvage treatment. Intraoperative samples were in favour of acute necrotizing myelitis. Discussion In the review of the literature, the inflammatory storm, vasculitis, and many unknown etiologies are deemed to be the possible causes of encephalopathy and myelitis after COVID-19 infection and vaccination. There are few cases of post-COVID-19 myelitis and hematomyelia, but this case was the first report of post-vaccination necrotizing myelitis. Conclusion Post-vaccination necrotizing myelitis is a lethal medical situation requiring intensive and emergent neurosurgical vigilance. Early clinical diagnosis in the beginning and full neurosurgical-neurological treatment armamentarium options are cornerstones of treatment paradigms. Salvage treatment options such as extensive laminectomy may play a life-saving role in treatment refractory cases of acute necrotizing myelitis.
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Affiliation(s)
| | | | | | | | - Mina Foroughi
- Isfahan Medical Student Research Committee (ISRC), Isfahan University of Medical Sciences
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Student Research Committee, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan, Iran
| | - Armin Sourani
- Isfahan Medical Student Research Committee (ISRC), Isfahan University of Medical Sciences
| | - Roham Nik Khah
- Isfahan Medical Student Research Committee (ISRC), Isfahan University of Medical Sciences
| | - Shaahin Veisi
- Isfahan Medical Student Research Committee (ISRC), Isfahan University of Medical Sciences
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Rezvani M, Sabouri M, Aminmansour B, Falahpour S, Sourani A, Sharafi M, Baradaran Mahdavi S, Foroughi M, Nik Khah R, Sourani A, Veisi S. Spontaneous spinal epidural haematoma following COVID-19 vaccination: a case report. Ann Med Surg (Lond) 2024; 86:612-619. [PMID: 38222759 PMCID: PMC10783308 DOI: 10.1097/ms9.0000000000001604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction COVID-19 vaccination side effects are rare but important medical situations. Spine-affecting side effects are amongst the rarest, but exceedingly important. Haemorrhagic spinal manifestations of COVID-19 and its vaccines are less reported with little knowledge about them. Case presentation An 80-year-old male who received his first shot of the COVID-19 vaccine had developed COVID-19 pneumonia, weakness, and sensory problems in his legs followed by sphincter incontinence within 5 days period. MRI showed a spontaneous epidural spinal epidural haematoma (SSEDH) in T10-L1. He underwent laminectomy and haematoma evacuation. One month follow-up showed no clinical improvement. Discussion To our knowledge, this was the first post-vaccination SSEDH and second in haemorrhagic spinal complications following COVID-19 vaccination. Considering the neuropathogenesis pathway of COVID-19 and its vaccines, there are common mechanisms of action that could potentially justify post-vaccination SSEDH such as seen in COVID-19 infection, itself. Early Neurosurgical intervention and better preoperative neurological status could be a beneficial modifier for favourable clinical outcomes. Conclusion SSEDH and COVID-19 vaccine coincidence is a rare clinical event, still no solid association could be scientifically explained. Further studies are required for a reliable pathophysiologic association. Early diagnosis, interdisciplinary medical approach, and faster intervention are the cornerstone of the treatment paradigm.
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Affiliation(s)
| | | | | | | | - Arman Sourani
- Department of Neurosurgery, School of Medicine
- Environment Research Center
| | | | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Student Research Committee, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease
| | - Mina Foroughi
- Isfahan Medical Students’ Research Committee (IMSRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roham Nik Khah
- Isfahan Medical Students’ Research Committee (IMSRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Armin Sourani
- Isfahan Medical Students’ Research Committee (IMSRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shaahin Veisi
- Isfahan Medical Students’ Research Committee (IMSRC), Isfahan University of Medical Sciences, Isfahan, Iran
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Sourani A, Vahdat N, Son C, Hariri OR, Rezvani M, Foroughi M, Mirza R, Sourani A, Baradaran Mahdavi S. SARS-CoV-2 infection and spontaneous spinal hemorrhage: a systematic review. Neurosurg Rev 2023; 46:300. [PMID: 37966587 DOI: 10.1007/s10143-023-02211-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/02/2023] [Accepted: 11/05/2023] [Indexed: 11/16/2023]
Abstract
The neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, including spontaneous spinal hemorrhage (SSH), are diverse. SSH is a detrimental neurosurgical event requiring immediate medical attention. We aimed to investigate the association between SARS-CoV-2 and SSH and delineate a rational clinical approach. The authors searched PubMed, Scopus, Web of Science, and Google Scholar for studies published up to January 25, 2023, on SSH and SARS-CoV-2 infection. For each dataset, the authors performed pooled estimates examining three outcomes of interest: (1) early post-intervention neurological status, (2) mortality, and (3) post-intervention neurological rehabilitation outcomes. After reviewing 1341 results, seven datasets were identified for the final analysis. Fifty-seven percent of patients were females. Twenty-eight percent of the patients experienced severe systemic infection. The mean interval between the SARS-CoV-2 infection and neurological presentation was 18 days. Pain and sensorimotor deficits were the most common (57%). Spinal epidural hematoma (EDH) was the most common presentation (71.4%). Three patients were treated conservatively, while 4 received neurosurgical intervention. Pain and sensorimotor deficits had the best treatment response (100%), while the sphincter had the worst response (0%). Long-term follow-up showed that 71% of patients had good recovery. SARS-CoV-2-associated SSH is a rare complication of infection, with an often insidious presentation that requires high clinical suspicion. Patients with SARS-CoV-2 infection and new neurological symptoms or disproportionate neck or back pain require a neuroaxis evaluation. Neurosurgical intervention and conservative management are both viable options to treat SSH following COVID-19. Still, a homogenous approach to the treatment paradigm of SSH cannot be obtained, but lesions with space-occupying effects are suitable for neurosurgical evacuation-decompression while more indolent lesions could be treated conservatively. These options should be tailored individually until larger studies provide a consensus.
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Affiliation(s)
- Arman Sourani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran.
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Noushin Vahdat
- Department of Radiology University of California, San Diego Health, San Diego, CA, USA
- Department of Radiology Veteran Administration Healthcare System, San Diego, CA, USA
| | - Colin Son
- Neurosurgical Associates of San Antonio, San Antonio, TX, USA
- School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX, USA
| | - Omid R Hariri
- Department of Neurological Surgery, Kaiser Permanente Orange County, Anaheim, CA, USA
| | - Majid Rezvani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mina Foroughi
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ryan Mirza
- Department of Radiology University of California, San Diego Health, San Diego, CA, USA
| | - Armin Sourani
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
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Damrow T, Bellinger R, Lin J, Walker JA. An Unusual Case of Acute Scrotal Pain. Cureus 2023; 15:e45221. [PMID: 37842505 PMCID: PMC10576437 DOI: 10.7759/cureus.45221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Patients frequently present to the emergency department with complaints of scrotal or testicular pain. Generally, there is an algorithmic approach to workup, which includes assessment for torsion, infection, or vascular causes, and musculoskeletal causes of pain are also sometimes considered. Spinal cord pathology, however, is less often explored as a cause of testicular pain. Here, we present a case of a 45-year-old man with end-stage renal disease and hypertension who presented with acute testicular pain. After a comprehensive workup, however, the source of pain was not initially found. Progression of the patient's symptoms led to the diagnosis of spontaneous spinal subdural hematoma. This atypical presentation of a rare diagnosis is also interesting due to the patient's concomitant diagnosis of an otherwise asymptomatic COVID-19 infection. While our case represents an atypical combination of clinical features, it also illustrates the importance of continued vigilance and ongoing workup when patients present with severe pain and unclear causes of their symptoms.
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Affiliation(s)
- Thomas Damrow
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
| | - Ryan Bellinger
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
| | - Judy Lin
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
- Department of Emergency Medicine, Burnett School of Medicine at Texas Christian University, Fort Worth, USA
| | - Jennifer A Walker
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
- Department of Emergency Medicine, Burnett School of Medicine at Texas Christian University, Fort Worth, USA
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Ahmed E, Saleh-Anaraki K, Onyegbule C, AlAfun M, Ammar HM. A Zebra Diagnosis: A Case of Spontaneous Hematomyelia Associated With COVID-19. Cureus 2023; 15:e40452. [PMID: 37456427 PMCID: PMC10349385 DOI: 10.7759/cureus.40452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Spontaneous non-traumatic spinal hematomyelia, characterized by intramedullary spinal hematoma, is a rare neurological emergency. Bleeding arteriovenous malformation, coagulopathies, and neoplasms are reported causes of this rare diagnosis. The authors present a case of a previously healthy man who presented with acute paraplegia and was found to have a spontaneous hematomyelia in association with covid infection. He underwent laminectomy and hematoma evacuation but did not recover any neurological function.
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Affiliation(s)
- Elham Ahmed
- Internal Medicine, University of Maryland Capital Region Medical Center, Largo, USA
| | - Kimia Saleh-Anaraki
- Internal Medicine, University of Maryland Capital Region Medical Center, Largo, USA
| | - Chima Onyegbule
- Internal Medicine, University of Maryland Capital Region Medical Center, Largo, USA
| | - Mamoon AlAfun
- Internal Medicine, University of Maryland Capital Region Medical Center, Largo, USA
| | - Hussam M Ammar
- Internal Medicine, University of Maryland Capital Region Medical Center, Largo, USA
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Sourani A, Rezvani M, Foroughi M, Baradaran Mahdavi S. Spontaneous intramedullary hematoma following COVID-19 vaccination: A case report. Clin Case Rep 2022; 10:e6743. [PMID: 36545562 PMCID: PMC9761661 DOI: 10.1002/ccr3.6743] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
A 67-year-old female was hospitalized due to right-sided hemiparesis and neck pain with rapid deterioration to a deep coma. She had received the Sinopharm vaccine 2 days earlier. MRI showed extensive cervicothoracic hematomyelia. She received intensive medical care for 2 months and was discharged. An 18-month follow-up showed significant neurological recovery.
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Affiliation(s)
- Arman Sourani
- Department of Neurosurgery, School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Majid Rezvani
- Department of Neurosurgery, School of Medicine Isfahan University of Medical Sciences Isfahan Iran
| | - Mina Foroughi
- Student Research Committee Isfahan University of Medical Sciences Isfahan Iran
| | - Sadegh Baradaran Mahdavi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Student Research Committee, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease Isfahan University of Medical Sciences Isfahan Iran
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