Case Presentation: 38-year-old male with no previous past medical history presented with cough, fatigue and myalgias in the setting of a known COVID infection (had tested positive the day prior). In the ED, he was found to have diffuse ST-segment changes on EKG concerning for pericarditis and an LVEF of 20% on echocardiogram. Due to risk of impending respiratory failure and cardiogenic shock, he was intubated, had an Impella device placed and a pericardiocentesis performed as he was found to have a pericardial effusion. Due to worsening cardiac function, he was cannulated for VA ECMO.His hospital course was complicated by loss of sensorimotor function and reflexes in his lower extremities from his waist down on day 17 of his hospitalization. Initial CT scans of his head and cervical/thoracic/lumbar spine were negative for any acute pathology. MRIs of his thoracic and lumbar spine, however, revealed an area between T11-L1 that was concerning for infarct with possible hemorrhage. Management included maintaining high mean arterial pressures while keeping in mind his precarious cardiovascular status and spinal cord hemorrhage. Anticoagulation was held until repeat CTs of his thoracic and lumbar spine showed no sign of obvious intrathecal hemorrhage. Follow-up MRIs of his thoracic and lumbar spine confirmed recent infarct in the area between T11-L1 and small hemorrhagic change within the conus.His hospital course was additionally complicated by oliguric AKI requiring CRRT, bilateral DVTs and ventilator associated pneumonia. However, he was ultimately able to be decannulated from ECMO, had a tracheostomy placed and was discharged to a long-term acute care hospital.
Discussion: Previously documented neurologic effects of COVID have been heterogeneous in nature. Commonly, COVID is known to cause anosmia and ageusia [1]. SARS-CoV-2 has also been documented to have neuro-invasive and neuro-inflammatory effects leading to consequences such as encephalopathy, myelitis and encephalitis [2]. Additionally, it has been shown to be pro-thrombotic, leading to cerebrovascular events such as ischemic strokes [3], which leads practitioners to obtain brain imaging for evaluation. Spinal imaging should also be considered when patients have loss of neurological function after COVID infection, as spinal infarction is a rare complication noted in a few case reports [4-7].
Conclusions: COVID-19 is known to cause a whole host of symptoms affecting multiple different organ systems of the body including associations with ischemic stroke and coagulopathic disorders such as DVT. If a patient presents with loss of neurological function, it is important to also consider more rare complications such as spinal cord infarction as there are few documented cases of this complication.