Acute Transverse Myelitis Cases after COVID Vaccinations

This article features several case reports of COVID-19-associated Acute Transverse Myelitis (ATM) following the COVID-19 vaccination.

Anatomy

Acute Transverse Myelitis is an inflammation of a segment of the whole spinal cord.

The spinal cord comes from the brain and is divided into the cervical (neck), thoracic (chest), lumbar (lower back), and sacrococcygeal (tailbone) segments.

Spinal nerves emerge out of each segment of the spinal cord. There are eight pairs of cervical,12 thoracic, five lumbar, five sacral, and one coccygeal pair of spinal nerves.

All nerves for motion and sensation of the arms, legs, and torso come from the spinal cord.

In the image below, the spinal cord is the big yellow nerve coming down from the brain. It is enclosed in the vertebral or spinal column.

What is Acute Transverse Myelitis (ATM)?

Transverse myelitis typically presents as a sudden acute onset of paralysis, numbness, and loss of sphincter control.

The involvement of the arms or the legs depends on the level of the spinal cord affected.

If the spinal cord segments in the neck and upper chest area are affected, both arms and legs will be involved. If it is lower, only the legs and sphincters will have problems.

COVID-19 and ATM

ATM is a rare neurological condition with only 1.34-4.6 cases per million/year.  However, there is a higher incidence of ATM among people who have COVID-19. According to Román et al., 2% of all neurological complications are caused by SARS-CoV-2 [1].

There are 43 patients with COVID-19-associated ATM from 21 countries that were published from March 2020 to January 2021.

There were 23 males (53%) and 20 females (47%) ranging from ages 21- to 73- years old (mean age, 49 years), with two peaks at 29 and 58 years.

The main clinical manifestations were quadriplegia or paralysis of all arms and legs (58%) and paraplegia (legs only) (42%).

Acute Transverse Myelitis after COVID-19 Vaccines

AstraZeneca

A previously healthy 72-year-old man presented to the emergency department at a hospital in Panama City, Panama, complaining of sudden difficulty urinating.

Three days later, the patient developed abnormal sensations in the arms and legs and weakness in all four limbs. The patient was alert and oriented; higher cortical functions, cranial nerves, and cerebellar examination were all intact. [1]

The patient was treated with a pulse dose of IV steroids, blood thinners, and intravenous gamma-globulin for five days. Oral prednisone was prescribed for the next 30 days.

He recovered partial strength in his upper limbs (4+/5), but the severe spastic paraplegia (1+/5) and the neurogenic bladder remained unchanged. He is undergoing physical therapy and rehabilitation treatment.

Three cases of ATM among 11,636 participants were reported during the clinical trials of the AstraZeneca COVID-19 vaccine.[1]

ATM case from Taiwan

Another case is from Taiwan. A 41-year-old man with diabetes under well medical control who works as an emergency physician received his first dose of the Astra Zeneca vaccine two weeks before the onset of symptoms.[2]

He first presented with left facial weakness, which resolved after oral steroids. In the following week, a tingling sensation over the nipple level (T4) was experienced,  followed by progressive paresthesia below the nipple line and lower-limb weakness and clumsiness, which developed in the 6th week after vaccination.

The contrast-enhanced spine MRI revealed a lesion over the spinal cord at the T1 to T6 vertebral levels.

He got treated with intravenous steroids that were switched to oral later.

Due to the patient having a major adverse event with the  AstraZeneca shot, the second dose of the vaccine was switched to the Moderna mRNA-1273 vaccine in the 14th week after the first dose, and no major adverse event has been observed until now.

The patient is now doing well under regular follow-up without neurological sequelae.

 Moderna COVID-19 (mRNA-1273) vaccine

A 76-year-old female presented with unsteadiness and abnormal sensation in the limbs, predominantly on the right side. She has no major significant comorbidities aside from hypertension and right-sided hearing impairment.[3]

Six days before admission, she received the COVID-19 vaccine (mRNA-1273, Moderna) in the morning (9 a.m.), after which she experienced intermittent low-grade fever (approximately 37–38 °C) in the evening (4 p.m.).

Additionally, she had right arm and leg paresthesia on post-vaccination day 2. She had no symptoms of mental deterioration, headache, neck rigidity, vertigo, nausea, vomiting, or fecal or urinary disturbance.

However, progressive gait disturbance and sacral paresthesia occurred on post-vaccination day 3.

A neuroimaging study of the brain and the cervical cord was performed on post-vaccination day 5, using magnetic resonance imaging (MRI).

Cervical-spine MRI revealed abnormalities at the C2–C5 levels on T2-weighted images and at the C3 level with T1 ring enhancement of the cervical cord.

Pt was treated in the hospital with intravenous steroids and then switched to oral steroids. Her gait improved without the assistance of a cane.

Pfizer mRNA vaccine ATM cases

The first one is an 81-year-old man who received the BNT162b2 vaccine. He presented with bilateral hand weakness. Spine magnetic resonance imaging (MRI) showed high signal intensity from the C1 to C3 vertebrae. [4]

The second is a 23-year-old woman who received the BNT162b2 vaccine and experienced tingling in her legs. Spine MRI showed a high signal intensity lesion at the conus medullaris. These patients were treated with intravenous methylprednisolone, and their symptoms improved slightly.[4]

More ATM cases

The table below shows the literature review of Hsiao et al. 2021 [3], showing the other Acute Transverse Myelitis Cases not covered in this article.

Reference	Age and Gender	Type of Vaccine	Onset Time *	Clinical Presentations	Involved Region	Management	Outcome
Notghi et al. [5]	58 Male	AstraZeneca	Seven days	Lower-limb numbness, genital dysesthesia, urinary incontinence, and hyperreflexia	T2–T10	IV methylprednisolone then oral prednisolone Plasmapheresis	Improved
Khan et al. [6]	67 Female	Moderna	One day	Four limbs’ weakness and hyperreflexia, and loss of vibration up to the ankle	C1–C3	IV Methylprednisolone and plasmapheresis	Improved
Tahir et al. [7]	44 Female	Johnson & Johnson	Seven days	Back pain, urinary retention, paresthesia in the neck and abdomen, numbness, weakness, and hyperreflexia in the lower extremities	C2–C3 and T2	IV prednisolone and plasmapheresis	Improved
Erdem et al. [8]	78 Female	CoronaVAC	Three weeks	Tetraparesis, urinary retention, and paresthesia of bilateral upper extremities	C1–T3	No information	No information
Pagenkopf et al. [9]	45 Male	AstraZeneca	One week	Thoracic back pain, urinary retention, acute flaccid tetraparesis, and sensory level at T9	C3–T2	IV prednisolone	Improved
Helmchen et al. [10]	40 Female	AstraZeneca	Two weeks	Back pain, incontinence, paraplegia, and paresthesia under the abdomen level	T7–T10 and optic neuritis	IV Methylprednisolone, plasmapheresis, and immunoadsorption	Improved
Singh et al. [11]	36 Male	AstraZeneca	Eight days	Abnormal sensations in both lower limbs and sense of vibration impaired up to the sternum	T2	IV Methylprednisolone	Improved
Vegezzi et al. [12]	44 Female	AstraZeneca (ABV 2856)	Four days	Bilateral plantar feet ascending paresthesia and reduced sensation in the lower back	T7–T8 and T10–T11	IV Methylprednisolone	Improved
This case report	41 Male	AstraZeneca	Two weeks	Paresthesia below T4, lower-limb weakness and clumsiness, loss of joint position and vibration, and hyperreflexia	T1–T6	IV Methylprednisolone and then oral prednisolone	Improved

Source: Hsiao et al. 2021

Why caused ATM after the COVID shots?

Molecular mimicry, autoimmunity, and epitope spreading are possible mechanisms.  Some genetic sequences in the SARS-CoV-2 spike proteins are similar to human genes. Hence antibodies produced against the spike protein will also attack human organs. [12][13]

There is also the possibility of spinal cord infarction due to thrombus formation induced by COVID-19 vaccination. There are several reports of thrombosis after COVID-19 vaccination, primarily with the AstraZeneca and the Johnson and Johnson vaccines.

RNA splice study shows why AstraZeneca and Janssen jabs are clot shots.

Personal thoughts

My former boss told us to have the COVID-19 vaccine. After reading about the reports of Acute Transverse Myelitis in the AstraZeneca trials, I decided that I should wait and read some more.

After I wrote about the Vojdani article and molecular mimicry in COVID-19, Autoimmunity, and Vaccination Part 2 in January 2021, I was convinced I would not get the shot. 

Truth heals. Lies kill. Don’t Get Sick!

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Related:

1. COVID-19, Autoimmunity and Vaccination, Part 1
2. COVID-19, Autoimmunity, and Vaccination Part 2
3. COVID-19, Autoimmunity, and Vaccination Part 3
4. Molecular Mimicry between the SARS-CoV-2 and the Breathing Center
5. Molecular mimicry between the spike protein and humans can shut down platelet production
6. Autoimmune antibodies and diseases after COVID-19 disease and injections

References:

1. Román GC, Gracia F, Torres A, Palacios A, Gracia K, Harris D. 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 Apr 26;12:653786. Doi: 10.3389/fimmu.2021.653786. PMID: 33981305; PMCID: PMC8107358.
2. Gao JJ, Tseng HP, Lin CL, Shiu JS, Lee MH, Liu CH. Acute Transverse Myelitis Following COVID-19 Vaccination. Vaccines (Basel). 2021 Sep 10;9(9):1008. doi: 10.3390/vaccines9091008. PMID: 34579245; PMCID: PMC8470728.
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Image credit: By Medium69, Jmarchn – File: Nervous system diagram.png, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=36395693

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