Three Patients With Chorea and Positive Voltage-Gated Potassium Channel Antibody: Is This the Link Between Hyperkinetic von Economo Disease and COVID-19?

Chorea, hemichorea, and other movement disorders have been reported after different pandemics since Constantin von Economo's time. In the current COVID-19 pandemic, numerous delayed neurological manifestations have been reported in the postinfectious or postvaccination periods. However, very few of these are movement disorders in nature; there are even fewer voltage-gated potassium channel (VGKC) antibody-related movement disorder cases in the literature. We encountered three patients with some COVID-19-related issues featuring both chorea and VGKC antibody. Modern medical science and technology may be able to further our understanding of the molecular basis of von Economo disease and reveal a possible link to COVID-19 along with the immunomodulation aspect of its treatment.

A Case of Acute Ischemic Stroke Treated With Alteplase Immediately After Transcatheter Aortic Valve Implantation: Which Procedures or Surgeries are Considered Contraindications to Thrombolytics?

Undergoing a major surgery within 14 days is considered a contraindication for intravenous alteplase. However, there is no consensus as to what qualifies as major surgery or an invasive procedure. Occasionally, determining whether a procedure is "invasive" or too risky in the setting of emergency ischemic stroke thrombolytic management can be challenging. Stroke neurologists may not be able to make such a decision on their own. Guidance or clearance from the physicians who performed the procedure is essential. We report the case of a patient who received intravenous alteplase after developing a stroke immediately following transcatheter aortic valve implantation (TAVI).

Novel Monoclonal Antibody Therapy in a Patient With Treatment-Refractory Warm Autoimmune Hemolytic Anemia.

In autoimmune hemolytic anemia (AIHA), hemolysis is the hallmark symptom. Cold agglutinin disease (CAD) and warm autoimmune hemolytic anemia (wAIHA) are the two major forms of AIHA. Hemolysis is complement dependent in CAD, whereas wAIHA is a partially complement-mediated disorder. At the time of writing, sutimlimab-jome is the only FDA-approved monoclonal antibody in the treatment of CAD. In a case of severe treatment-refractory wAIHA, a two-week course with sutimlimab-jome resulted in a sustained decrease in total bilirubin level and a notable reduction in transfusion requirement, suggesting that it is also effective in the treatment of wAIHA.

Bell's Palsy after second dose of Pfizer COVID-19 vaccination in a patient with history of recurrent Bell's palsy.

OBJECTIVE: To report a patient with history of recurrent Bell's Palsy who developed Bell's Palsy 36 â€‹h after the administration of the second dose of the Pfizer-BioNTech COVID-19 vaccine. CASE: The patient is a 57-year-old female with past medical history of 3 episodes of Bell's Palsy. She responded to prednisone treatment and returned to her baseline after each occurrence. Less than 36 â€‹h following the second dose of the vaccine, the patient developed a left Bell's Palsy. The facial droop progressed in severity over the next 72 â€‹h. CONCLUSION: Given the expedited production of the vaccine and the novelty associated with its production, there may be information pertaining to side effects and individual response that remain to be discovered. Since both the Moderna and Pfizer Vaccine trials reported Bell's Palsy as medically attended adverse events, the association between vaccine administration and onset of symptomatic Bell's Palsy may warrant further investigation.

"Highlighting" red nuclei by atypical posterior reversible encephalopathy syndrome in a patient with systemic lupus erythematosus.

This is a case report in which a patient with SLE had a brainstem variant of PRES, and MRI demonstrated atypical distribution of FLAIR hyperintensity in the thalami and the midbrain sparing the red nuclei bilaterally (Figure 1). This impressive lesion pattern may reveal the disease mechanisms of PRES in patients with SLE.

Rapid Ascending Sensorimotor Paralysis, Hearing Loss, and Fatal Arrhythmia in a Multimorbid Patient due to an Accidental Overdose of Fluoxetine.

BACKGROUND: Common side effects of selective serotonin reuptake inhibitors (SSRIs) include tachycardia, drowsiness, tremor, nausea, and vomiting. Although SSRIs have less toxic side effects compared to more traditional antidepressants, serious and life threatening cases of SSRI overdose have been reported. We describe a 24-year-old multimorbid female who presented to the emergency department with rapid onset ascending sensorimotor paralysis, complicated by respiratory and cardiac arrest, found to have fatal levels of fluoxetine by toxicological analysis, not taken in a suicidal act. RESULTS: Autopsy was performed at the Los Angeles County Medical Examiner's Office of a female with no evidence of traumatic injury. Toxicological analysis revealed lethal levels of fluoxetine, toxic levels of diphenhydramine, and multiple other coingested substances at nontoxic levels. Neuropathological examination of the brain and spinal cord revealed no evidence of Guillain-Barre paralysis. CONCLUSIONS: Lethal levels of fluoxetine and multiple potential drug-to-drug interactions in our patient likely contributed to her unique signs and symptoms. This is the first case reporting neurologic signs and symptoms consisting of rapid onset ascending sensorimotor paralysis, hearing loss, respiratory failure, cardiac arrest, and death in a patient with lethal levels of fluoxetine.