• The first CNS demyelinating events can occur associated
with SARS-CoV-2 infection.
• Active delayed demyelination can be developed within
the first three months after SARS-CoV-2 infection.
• This can be explained with the initiation of the active
disease process by COVID-19.
• All of the cases present with pyramidal or brain stem
findings that suggests the moderate activity.
• Newly diagnosed Multiple Sclerosis could be develop
during the COVID-19 pandemic.
Introduction: To describe the parainfectious or postinfectious effects of
COVID-19 infection on the first demyelinating presentation of Multiple
Sclerosis and tumefactive demyelinating lesion (TDL) developing with
Longitudinally Extensive Transverse Myelitis (LETM).
Methods: We present six patients who presented with a first CNS
demyelination event or whose demyelinating lesions had aggravated
after COVID-19 infection between May and December 2020.
Nasopharyngeal swab SARS-CoV-2 PCR positivity was detected in
five cases and cerebrospinal fluid (CSF) PCR was positive in one. The
symptoms, neurological signs, radiological and CSF findings of the cases
Results: A 24-year-old woman presented with LETM aggravated by
COVID-19, accompanied by a newly developed open-ring enhanced
TDL. Four patients were diagnosed with the first presentation of MS,
and one presented with clinically isolated syndrome according to the
McDonald 2017 criteria. The interval between SARS-CoV-2 infection
and the onset of clinical symptoms ranged from 4–93 days. All of the
cases present with pyramidal or brain stem findings and have high brain
and/or spinal MRI load. This suggests the moderate activity of CNS
demyelinating disease after COVID-19 infection.
Conclusions: Based on this case series, all these first demyelinating
events suggested that COVID-19 infection might trigger or exacerbate
CNS demyelinating disease. SARS-CoV-2 plays a role in the clinical
onset of Multiple Sclerosis. Active delayed demyelination developed
within the first three months. This can be explained by COVID-triggered
neuroimmune response that had been latent, and the initiation of the
active disease process began with triggering or aggravation of the lesions
in MRI. Multiple Sclerosis should be maintained during the COVID-19
Keywords: COVID-19, longitudinally extended transverse myelitis,
magnetic resonance imaging, multiple sclerosis, SARS-CoV-2,
tumefactive demyelinating lesion