Response to Letter to the Editor: Spinomedullary Weston Hurst Syndrome After COVID-19 and Influenza Co-Infection

• Type of Material: Article
• Authors: Spencer Hutto, Emory University; Nagagopal Venna, Massachusetts General Hospital
• Language: English
• Date: 2022-10-01
• Publisher: SAGE Publishing
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022
• Final Published Version (URL): http://dx.doi.org/10.1177/19418744221109218
• Title of Journal or Parent Work: Neurohospitalist
• Volume: 12
• Issue: 4
• Start Page: 711
• End Page: 712
• Grant/Funding Information: The author(s) received no financial support for the research, authorship, and/or publication of this article.
• Keywords: influenza; case report; acute hemorrhagic leukoencephalitis; COVID-19; Weston hurst disease
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Given the novelty of neuroinflammatory complications associated with COVID-19, we agree that alternative etiologies should be thoroughly sought and refuted. For this very reason, we were careful to highlight in Tables 1 and 2 the extensive laboratory testing of serum and CSF specimens that occurred in this case, including all of the potential alternative diagnoses suggested in the letter. 1 In the initial phase of the diagnostic work-up, we were equally concerned about the possibility for sarcoidosis and malignancy (lymphoma included) as well as non-inflammatory myelopathies (including vascular myelopathies, such spinal cord infarction and dural arteriovenous fistulas), which sparked our decision to obtain whole body PET CT and MRA of spinal blood vessels, both of which were unrevealing of abnormalities to suggest an alternative diagnosis. CLIPPERS most commonly manifests radiographically as punctate or curvilinear areas of enhancement centered predominantly in the pons and cerebellum; the large lesion in the medulla of our patient with confluent longitudinal extension into the spinal cord would be very atypical for this disorder (as illustrated in Figure 1).1,2 With such extensive testing conducted, we believe that alternative etiologies were thoroughly investigated and appropriately excluded as outlined in the original report.