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 42-year-old man presented with difficulty speaking, cognitive deficits, ataxia, and progressive disabling jerks in upper and lower limbs, leading to falls (see Supplementary video-). Neurological examination demonstrated spontaneous, action-induced, and tactile-sensitive myoclonus on the face, upper extremities, and lower extremities. He had dysmetria and dysdiadochokinesia with superimposed action-induced myoclonus in the upper and lower extremities. Myoclonus prevented him from standing independently, and he had a wide-based gait. The rest of the neurological examination was normal. Laboratory tests including renal function, liver function, ammonium, urea, and CO2 were normal, except for the nasopharyngeal RT-PCR test for SARS-CoV-2, which was positive. Computed tomography (CT) of the head and brain magnetic resonance imaging (MRI) were normal. Electroencephalogram (EEG) and electromyography (EMG) were performed but did not reveal any abnormalities. Given these findings and the positive SARS-CoV-2 PCR, myoclonus was considered postinfectious. No other symptoms such as fever, myalgia, cough, fatigue, hyposmia, or hypogeusia were present. Cerebrospinal fluid (CSF) analysis was unremarkable, RT-PCR test for SARS-CoV-2 and autoantibodies were negative. He was treated with methylprednisolone 1000 mg IV daily for five days, bringing about a partial resolution of myoclonus. Complete recovery was observed on a follow-up session one month later.