Marc Moisi , Christian Bowers , Smit Shah , Sina Zoghi , Carmelo Venero Jr , Shubham Arora , Sara Mirza , Abilash Haridas , Noushin Vahdat , Mina Foroughi , Sadegh Baradaran Mahdavi , Arman Sourani
{"title":"A systematic review on COVID-19 and spinal strokes, the end of an era","authors":"Marc Moisi , Christian Bowers , Smit Shah , Sina Zoghi , Carmelo Venero Jr , Shubham Arora , Sara Mirza , Abilash Haridas , Noushin Vahdat , Mina Foroughi , Sadegh Baradaran Mahdavi , Arman Sourani","doi":"10.1016/j.jocn.2025.111639","DOIUrl":null,"url":null,"abstract":"<div><h3>Aim</h3><div>To investigate the association of the COVID-19 virus with hemorrhagic and ischemic spinal strokes.,</div></div><div><h3>Background</h3><div>COVID-19 has extensive extrapulmonary manifestations. Myelitis, demyelinating syndromes, hemorrhagic and ischemic presentations have been reported. To date, there is no comprehensive study to delineate an evidence-based correlation between COVID-19 and spinal strokes comprehensively.</div></div><div><h3>Materials and methods</h3><div>A PRISMA-based systematic review.</div></div><div><h3>Results</h3><div>In the final review, 8 data sets for ischemia and 11 for hemorrhagic lesions were included.</div><div>The mean age for ischemia and hemorrhagic lesions was 52 and 47 years old, respectively. Patients with cord ischemia had more severe COVID-19 pneumonia as compared to hemorrhagic (62 % vs 27 %). Lab results showed 75 % coagulation abnormalities in cord ischemia patients while there was no coagulopathy in the hemorrhage group. Somatosensory deficits were the most prevalent neurological presentations in both groups.</div><div>MRI showed that the anterior spinal artery and central ischemia were the most common patterns of COVID-19 spinal ischemia. MRI images also revealed epidural and intramedullary hematomas were the most common type of hemorrhagic lesions with cervical and thoracic preferences.</div><div>The most common on-admission neurological status was American Spinal Injury Association (ASIA) impairment scale A-B(ischemia) and ASIA B-D(hemorrhage). All of the ischemic patients received conservative management. In hemorrhagic patients, there were 4 laminectomies, 6 conservative management, and 1 combined approach.</div><div>Post-intervention clinical outcomes in ischemia were unfavorable but in the hemorrhagic spinal strokes, it had more promising results.</div></div><div><h3>Conclusion</h3><div>COVID-19 can cause both ischemia and hemorrhagic spinal strokes. Coagulopathy may be a precipitating factor in cord ischemia development while other neuropathogenesis mechanisms may precipitate spinal hemorrhage. Early surgical or conservative management is the key factor in determining long-term outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"142 ","pages":"Article 111639"},"PeriodicalIF":1.8000,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Neuroscience","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0967586825006125","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Aim
To investigate the association of the COVID-19 virus with hemorrhagic and ischemic spinal strokes.,
Background
COVID-19 has extensive extrapulmonary manifestations. Myelitis, demyelinating syndromes, hemorrhagic and ischemic presentations have been reported. To date, there is no comprehensive study to delineate an evidence-based correlation between COVID-19 and spinal strokes comprehensively.
Materials and methods
A PRISMA-based systematic review.
Results
In the final review, 8 data sets for ischemia and 11 for hemorrhagic lesions were included.
The mean age for ischemia and hemorrhagic lesions was 52 and 47 years old, respectively. Patients with cord ischemia had more severe COVID-19 pneumonia as compared to hemorrhagic (62 % vs 27 %). Lab results showed 75 % coagulation abnormalities in cord ischemia patients while there was no coagulopathy in the hemorrhage group. Somatosensory deficits were the most prevalent neurological presentations in both groups.
MRI showed that the anterior spinal artery and central ischemia were the most common patterns of COVID-19 spinal ischemia. MRI images also revealed epidural and intramedullary hematomas were the most common type of hemorrhagic lesions with cervical and thoracic preferences.
The most common on-admission neurological status was American Spinal Injury Association (ASIA) impairment scale A-B(ischemia) and ASIA B-D(hemorrhage). All of the ischemic patients received conservative management. In hemorrhagic patients, there were 4 laminectomies, 6 conservative management, and 1 combined approach.
Post-intervention clinical outcomes in ischemia were unfavorable but in the hemorrhagic spinal strokes, it had more promising results.
Conclusion
COVID-19 can cause both ischemia and hemorrhagic spinal strokes. Coagulopathy may be a precipitating factor in cord ischemia development while other neuropathogenesis mechanisms may precipitate spinal hemorrhage. Early surgical or conservative management is the key factor in determining long-term outcomes.
期刊介绍:
This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology.
The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.