A 26-year-old female patient with a past medical history of obesity, post-traumatic stress disorder, depression, and exercise-induced asthma presented to the emergency department with sudden onset of headache, vomiting, and right-sided numbness, and tingling. The patient underwent computed tomography (CT) angiography of the head and neck, which were unremarkable, and no vertebral artery dissection was seen. She was discharged with the diagnosis of migraine.\nShe developed worsening of her symptoms at home, presenting again to the emergency department with increasing right-sided numbness, weakness, and dysarthria. Vital signs were stable with no fever. The patient reported no respiratory symptoms and denied any recent head trauma or chiropractic neck manipulation. The neurological exam was significant for right-sided weakness, dysarthria, right-sided dysmetria, and gait ataxia. Chest X-ray showed no acute infiltrates. Magnetic resonance imaging (MRI) of the brain showed an acute right cerebellar infarct with the involvement of the right cerebellar peduncle (Figure ). Magnetic resonance angiography of the head revealed narrowing of the right superior cerebellar artery (Figure ). An echocardiogram with a bubble study was performed, as well as a part of a stroke workup, which showed a PFO. The lower extremity venous doppler ultrasound was negative for deep venous thrombosis. The laboratory test results are shown in Table .\nThe patient was screened for COVID-19 with a nasopharyngeal reverse transcription polymerase chain reaction due to increased reports of stroke in young patients nationwide, and the test came back as positive, to our surprise. Standard stroke treatments, including aspirin, clopidogrel, and high-intensity statins, were initiated for the patient. Enoxaparin for deep venous thrombosis prophylaxis was also prescribed.
A previously healthy 52-year-old man presented with progressive imbalance and generalized jerks (see Supplementary video-). A week before, he had experienced myalgia and tested positive for SARS-CoV-2. Upon admission, he had generalized stimulus-sensitive myoclonus affecting his face, hands, and legs, confining him to a wheelchair. Other neurological findings, including eye movements, muscle tone, and deep tendon reflexes, were normal. He did not have any coughing, fever, dyspnea, and O2 saturation was more than 97% without nasal O2. Ground-glass opacities suggestive of SARS-CoV-2 infection were detected on chest CT. Laboratory studies showed no increase in inflammatory markers in peripheral blood; CRP and white blood cell count were normal. Brain CT and MRI were normal. Results from CSF evaluations, including autoantibody investigations, were unremarkable. The cerebellar syndrome improved after high-dose IV methylprednisolone (1 gr/day for five days); on a follow-up session after three weeks, the patient could walk independently.