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 38-year-old man was referred to our clinic with generalized jerks in his hands (see Supplementary video-). A week before, he had been discharged from the hospital after four days of hospitalization due to a positive nasopharyngeal RT-PCR test and evident involvement of his lungs. Four days after discharge, he developed fine jerks in his hands and could not write; three days later, he was referred to our clinic with progression and generalization of jerks. He had generalized myoclonus in upper and lower limbs and bizarre abnormal movements that diminished with distraction; he was also restless and seemed anxious. The rest of the neurological examinations were normal. Lab tests were unremarkable. Laboratory investigations and brain MRI scans were normal. CSF analyses, including cell count, protein, and autoimmune panel, were normal. Clonazepam (2 mg/day), levetiracetam (1000 mg/day), and IV methylprednisolone for 5 days (1 g/day) were started, resulting in partial improvement. After two weeks, myoclonus was resolved; functional movements improved with some residual deficits, but he was still suffering from anxiety.