Summary: Researchers have documented a notable cluster of acute transverse myelitis (ATM) cases associated with COVID-19. ATM is an inflammatory disorder of the spinal cord that can cause spinal cord lesions, paralysis, and bowel or bladder dysfunction.
Source: Houston Methodist
Researchers working with Houston Methodist have conducted an international review that identified 43 cases of acute transverse myelitis (ATM) occurring in patients with COVID-19. This finding suggests that ATM, although typically rare, may be an underrecognized neurological complication following SARS-CoV-2 infection.
The study was led by neurologist Dr. Gustavo Roman and assembled case reports and clinical data from 21 countries. The patients developed spinal cord inflammation and lesions after contracting COVID-19, presenting with symptoms that in many cases led to significant disability.
Common clinical features included varying degrees of paralysis and sphincter or bowel dysfunction. The cohort included both men and women nearly equally, with ages spanning from 21 to 73 years. The diversity of ages and geographic locations underscores the importance of global clinical awareness.
In the general population, ATM is rare, with historical incidence estimates between 1.34 and 4.6 cases per million people per year. The concentration of cases identified among COVID-19 patients in this review prompted the authors to call for further investigation into possible links between SARS-CoV-2 infection and spinal cord inflammation.
The review also notes that three ATM cases were reported as serious adverse events during clinical trials of the Oxford–AstraZeneca COVID-19 vaccine (ChAdOx1 nCoV-19, AZD1222), drawing attention to the need for careful post-vaccination surveillance while recognizing that causality remains to be fully established.
The full study is published in the peer-reviewed journal Frontiers in Immunology.
Dr. Roman collaborated with colleagues from Hospital Paitilla, Interamerican University of Panama, and Hospital Santo Tomás, including Drs. Fernando Gracia, Antonio Torres, Alexis Palacios, Karla Gracia, and Diogenes Harris.
About this neurology and COVID-19 research news
Source: Houston Methodist
Contact: Patti Muck – Houston Methodist
Image: The image is in the public domain
Original Research: Open access. “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)” by Gustavo Roman et al., published in Frontiers in Immunology.
Abstract
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)
Introduction: Acute transverse myelitis (ATM) is an uncommon neurologic condition, but clinicians have observed cases in temporal association with COVID-19. Given its potential for severe neurologic impairment, understanding its relationship to SARS-CoV-2 infection is a clinical priority.
Case-finding methods: The authors report a case from Panama and performed a systematic clinical review of 43 patients with COVID-19-associated ATM published between March 2020 and January 2021 from 21 countries. The review also documents three ATM cases reported as serious adverse events during clinical trials of the ChAdOx1 nCoV-19 (AZD1222) vaccine.
Results: All reviewed patients displayed characteristic features of ATM: acute onset of motor weakness or paralysis, a defined sensory level, and sphincter dysfunction consistent with spinal cord lesions confirmed on imaging. The group comprised 23 males (53%) and 20 females (47%), ages 21 to 73 (mean age 49), with two incidence peaks at approximately 29 and 58 years; three pediatric cases were excluded from peak calculations. Clinically, 58% presented with quadriplegia and 42% with paraplegia.
MRI data, available for 40 patients, revealed two primary patterns: localized lesions affecting three or fewer spinal cord segments (12 cases, 30%) found at cervical or thoracic levels, and longitudinally extensive transverse myelitis (LEATM) involving four or more spinal cord segments (28 cases, 70%). LEATM commonly spanned cervicothoracic regions in 18 patients and thoracolumbar–sacral regions in 10 patients. Additional inflammatory central nervous system disorders were observed: eight patients developed acute disseminated encephalomyelitis (ADEM), predominantly women, three patients had optic involvement consistent with myeloneuritis optica (MNO) leading to blindness, and two patients showed features of acute motor axonal neuropathy (AMAN).
Conclusions: The review identified ATM as a relatively frequent neurological complication observed in people with COVID-19, more commonly than expected based on baseline population rates. The timing of onset varied: approximately 68% of cases began 10 days to six weeks after initial infection, a pattern suggesting post-infectious immune-mediated mechanisms. In contrast, about 32% had a short latency of 15 hours to five days, which may indicate a possible direct neurotropic effect of the virus in some instances. The report also highlights the occurrence of three ATM cases among 11,636 participants in AZD1222 vaccine trials—an incidence that the authors consider notable relative to the estimated background rate of COVID-19-associated ATM.
While the precise pathogenesis remains uncertain, the authors propose that immune responses to SARS-CoV-2 antigens—or, hypothetically, to vaccine antigens or adjuvants—could trigger inflammatory processes targeting the spinal cord in susceptible individuals. These observations underline the need for continued surveillance, detailed case reporting, and mechanistic research to clarify causality, risk factors, and optimal strategies for diagnosis, treatment, and prevention of ATM related to SARS-CoV-2 infection or vaccination.