Острый рассеянный энцефаломиелит (ОРЭМ) и острый поперечный миелит (ОПМ) – аутоиммунные демиелинизирующие заболевания центральной нервной системы. Представлены 2 клинических наблюдения ОРЭМ и ОПМ, развившихся после перенесенной острой коронавирусной инфекции (SARS-CoV-2). Дифференциальная диагностика проводилась с рассеянным склерозом, энцефалитом инфекционной природы, компрессионной миелопатией, заболеванием из спектра оптиконевромиелита. В обоих наблюдениях отмечено практически полное восстановление утраченных функций. Обсуждаются патогенетические механизмы развития ОРЭМ и ОПМ у пациентов с коронавирусной инфекцией. Возникновение дизиммунного поражения центральной нервной системы на фоне коронавирусной инфекции диктует необходимость мониторирования клинической ситуации с участием невролога для своевременной диагностики и определения терапевтической тактики, что может уменьшить степень инвалидизации пациентов.
Acute disseminated encephalomyelitis (AEM) and acute transverse myelitis (OPM) are autoimmune demyelinating diseases of the central nervous system. Two clinical observations of AEM and OPM developed after suffering acute coronavirus infection (SARS-CoV-2) are presented. Differential diagnosis was carried out with multiple sclerosis, encephalitis of an infectious nature, compressive myelopathy, and opticomyelitis. Both observations show an almost complete recovery of lost functions. The pathogenetic mechanisms of the development of AEM and OPM in patients with coronavirus infection are discussed. The onset of central nervous system dysimmune lesion in the context of coronavirus infection makes it necessary to monitor the clinical situation with the involvement of a neurologist for timely diagnosis and determination of therapeutic tactics that can reduce the degree of disability of patients.
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1. Divani AA, Andalib S, Biller J, at al. Central Nervous System Manifestations Associated with COVID-19. Curr Neurol Neurosci Rep. 2020;20(12):1-20. DOI:10.1007/s11910-020-01079-7
2. Paterson RW, Brown RL, Benjamin L, et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain. 2020;143:3104-20. DOI:10.1093/brain/awaa240
3. Varatharaj A, Thomas N, Ellul MA, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020;7:875-82. DOI:10.1016/S2215-0366(20)30287-X
4. Maury A, Lyoubi A, Peiffer-Smadja N, et al. Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians. Rev Neurol (Paris). 2021;177(1‑2):51‑64. DOI:10.1016/j.neurol.2020.10.001
5. Neurology (national guide). Ed. EI Gusev, AN Konovalov, VI Skvortsova. 2018. Moscow: GEOTAR-Media. Vol. 1. P. 478-83, 489-95 (in Russian).
6. Koelman DLH, Chahin S, Mar SS, et al. Acute disseminated encephalomyelitis in 228 patients: a retrospective, multicenter US study. Neurology. 2016;86(22):2085-93. DOI:10.1212/WNL.0000000000002723
7. Parsons T, Banks S, Bae C, et al. COVID-19-associated acute disseminated encephalomyelitis (ADEM). J Neurol. 2020. DOI:10.1007/s00415-020-09951-9
8. Lopes CCB, Brucki SMD, Passos Neto CEB, et al. Acute Disseminated Encephalomyelitis in COVID-19: presentation of two cases and review of the literature. Arq Neuropsiquiatr. 2020;78(12):805-10. DOI:10.1590/0004-282X20200186
9. McCuddy M, Kelkar P, Zhao Y, Wicklund D. Acute Demyelinating Encephalomyelitis (ADEM) in COVID-19 Infection: A Case Series. Neurol India. 2020;68(5):1192-5.
DOI:10.4103/0028-3886.299174
10. Otluoglu GD, Yener U, Demir MK, Yilmaz B. Encephalomyelitis associated with COVID-19 infection: Case report. Br J Neurosurg. 2020;1–3. DOI:10.1080/02688697.2020.1787342
11. Novi G, Rossi T, Pedemonte E, et al. Acute disseminated encephalomyelitis after SARS-CoV-2 infection. Neurol Neuroimmunol Neuroinflamm. 2020;7(5):e797. DOI:10.1212/NXI.0000000000000797
12. Utukuri PS, Bautista A, Lignelli A, Moonis G. Possible acute disseminated encephalomyelitis related to severe acute respiratory syndrome coronavirus 2 infection. AJNR Am J Neuroradiol. 2020;41(9):E82-3. DOI:10.3174/ajnr.A6714
13. Langley L, Zeicu C, Whitton L, Pauls M. Acute disseminated encephalomyelitis (ADEM) associated with COVID-19. BMJ Case Rep. 2020;13(12):e239597. DOI:10.1136/bcr-2020-239597
14. Hussein O, Abd Elazim A, Torbey MT. COVID-19 systemic infection exacerbates pre-existing acute disseminated encephalomyelitis (ADEM). J Neuroimmunol. 2020;349:577405. DOI:10.1016/j.jneuroim.2020.577405
15. Reichard RR, Kashani KB, Boire NA, et al. Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM) like pathology. Acta Neuropathologica. 2020;140:1-6. DOI:10.1007/s00401-020-02166
16. Román GS, Gracia F, Torres A, et al. Acute Transverse Myelitis (ATM): Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222). Front Immunol. 2021;12:653786. DOI:10.3389/fimmu.2021.653786
17. Águila-Gordo D, Manuel Flores-Barragán J, Ferragut-Lloret F, et al. Acute myelitis and SARS-CoV-2 infection. A new etiology of myelitis? J Clin Neurosci. 2020;80:280-1. DOI:10.1016/j.jocn.2020.07.074
18. Zubair AS, McAlpine LS, Gardin T, et al. Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: A review. JAMA Neurol. 2020;77:1018-27. DOI:10.1001/jamaneurol.2020.2965
19. Ng Kee Kwong KC, Mehta PR, Shukla G, Mehta AR. COVID-19, SARS and MERS: A neurological perspective. J Clin Neurosci. 2020;7:13-6. DOI:10.1016/j.jocn.2020.04.124
20. Boyko AN, Sivertseva SA, Spirin NN. Nervous system damage in COVID-19 with an emphasis on the management of patients with multiple sclerosis. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(Suppl. 1):44-7 (in Russian). DOI:10.14412/2074-2711-2020-1S-44-47
21. Belopasov VV, Yachou Y, Samoilova EM, Baklaushev VP. The Nervous System Damage in COVID-19. Journal of Clinical Practice. 2020;11(2):60-80 (in Russian).
DOI:10.17816/clinpract34851
22. Sarma D, Bilello LA. A case report of acute transverse myelitis following novel coronavirus infection. Clin Pract Cases Emerg Med. 2020;4:321-3. DOI:10.5811/cpcem.2020.5.47937
23. Advani S, Zali A, Ommi D, et al. Transverse myelitis in COVID-19 patients: Report of two cases. Res Square. 2020. Preprint. DOI:10.21203/rs.3.rs-107744/v1
24. Valiuddin H, Skwirsk B, Paz-Arabo P. Acute transverse myelitis associated with SARS-CoV-2: A case report. Brain Behav Immun Health. 2020;5:100091. DOI:10.1016/j.bbih.2020.100091
25. Zachariadis A, Tulbu A, Strambo D, et al. Transverse myelitis related to COVID-19 infection. J Neurol. 2020;267:3459-61. DOI:10.1007/s00415-020-09997-9
26. Garg RK, Paliwal VK, Gupta A. Spinal cord involvement in COVID-19: A review. J Spinal Cord Med. 2021:1-15. DOI:10.1080/10790268.2021.1888022
27. AlKetbi R, AlNuaimi D, AlMulla M, et al. Acute myelitis as a neurological complication of COVID-19: A case report and MRI findings. Radiol Case Rep. 2020;15:1591-5.
DOI:10.1016/j.radcr.2020.06.001
28. Chakraborty U, Chandra A, Ray AK, Biswas P. COVID-19-associated acute transverse myelitis: A rare entity. BMJ Case Rep. 2020;13:e238668. DOI:10.1136/bcr-2020-238668
29. Munz M, Wessendorf S, Koretsis G, et al. Acute transverse myelitis after COVID-19 pneumonia. J Neurol. 2020;267(8):2196-7. DOI:10.1007/s00415-020-09934-w
30. Luis MB, Liguori NF, López PA, Alonso R. SARS-CoV-2 RNA detection in cerebrospinal fluid: Presentation of two cases and review of literature. Brain Behav Immun Health. 2021;15:100282. DOI:10.1016/j.bbih.2021.100282
31. Voskresenskaya ON, Kovalenko АА, Nadbitova ЕB, et al. Central pontine myelinolysis in the presence of SARS-CoV-2 infection (clinical observations). Neurology, Neuropsychiatry, Psychosomatics. 2021;13(2):91-6 (in Russian). DOI:10.14412/2074-2711-2021-2-91-96
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*luiziana78@mail.ru
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Luiza T. Akhmedzhanova*, Olga N. Voskresenskaia, Aleksei I. Isaikin, Elizaveta V. Ermilova, Tatiana I. Nasonova, Pavel A. Chernousov, Vladimir V. Rusin
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*luiziana78@mail.ru