Abstract
We herein report two cases of tractopathy affecting the bilateral corticospinal tracts (CSTs) and the spinal cord following coronavirus disease 2019. Both patients developed progressive sensorimotor deficits with spasticity, a truncal sensory level with severely impaired deep sensation, and bowel/bladder dysfunction one to three months post-infection. Magnetic resonance imaging revealed bilateral CST and lateral column lesions. Somatosensory evoked potentials confirmed posterior column dysfunction. Initial treatment with intravenous methylprednisolone and immunoglobulin was ineffective; however, multiple courses of immunotherapy and prolonged corticosteroids led to marked improvement. These cases suggest a tract-specific, delayed, immune-mediated process triggered by severe acute respiratory syndrome coronavirus 2, underscoring the need for extended immunotherapy for optimal recovery.