The novel Coronavirus-19 (COVID-19) outbreak has brought unprecedented implications globally for the medical community and continues to present challenges when delivering neurological care and intervention. Here we describe six patients with acute cerebrovascular symptoms and concurrent COVID-19 infection who presented to our hospital. This is a retrospective case series study of six patients presenting with neurological, either with or without respiratory symptoms. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was suspected in the patients. Testing was conducted by BioReference Lab with the reverse-transcriptase polymerase chain reaction (RT-PCR) assay for most patients. Brain imaging revealed evidence of acute cerebral infarction. Ethical approval and informed consent waivers when appropriate were granted by the Mount Sinai Institutional Review Board. The study was conducted at NYC Health + Hospitals-Queens in Jamaica, New York. All patients were men, ages 39 to 69 years, four of whom were found to have associated risk factors for stroke. Inflammatory markers were elevated in most patients and brain imaging revealed ischemic infarcts. With the exception of one patient who expired, five patients made a significant recovery. Ischemic stroke was one of many newfound complications related to the COVID-19 infection. In our case reports, many patients did not present with respiratory symptoms, however, all tested positive for COVID-19. Neurological sequelae related to COVID-19 apart from cerebrovascular disease continue to be discovered. With growing evidence that the central nervous system is vulnerable to the devastating effects of COVID-19, testing should be expedited in all patients presenting with neurological symptoms during the COVID-19 pandemic.

Background: P-glycoprotein (P-gp) is a drug efflux transporter present in the blood brain barrier whose function was suggested to be modified by a genetic polymorphism affecting ABCB1 C3435T gene at exon 26. Overexpression was related to homozygous C allele in some studies, however other studies in different ethnic populations showed relation to homozygous T allele, furthermore others failed to confirm any relation to resistance to therapeutic effects of AEDs. Aim of the study: Our aim is to find out the association between C3435T polymorphism and pharmacoresistance in idiopathic epilepsy in order to identify early the pharmacoresistant patients so we can select the proper AED and other proper therapeutic modalities. Patients and methods: Our case-control study was conducted on 44 idiopathic epileptic patients (22 drug-resistant and 22 drug-responsive epilepsy) and 44 healthy controls of comparable age and sex. Blood samples were obtained. Allele and genotype frequencies were evaluated between our study groups and their association with pharmacoresistance, some historical and semiology of epilepsy. Results: Our work revealed a lower risk of drug resistance in patients with the genotype CT (OR: 0.8) in comparison to genotypes CC and TT (OR: 1.2, 1 respectively) but the results were not statistically significant. However, significant association regarding daytime seizures was found with genotype CC in comparison to genotypes CT and TT. Conclusion: Daytime seizures were found to be more prevalent among those with CC genotype and this association was significant. The risk of drug resistant epilepsy was lower in patients with CT than those with CC and TT genotypes, but this association was not statistically significant in our study.

Platelet activation in cerebrovascular diseases is associated with recurrent stroke and death. Aspirin is an effective antiplatelet agent, exhibiting its action by irreversibly inhibiting platelet cyclooxygenase-1 enzyme, thus preventing the production of thromboxane A2 (TXA2). Objectives: The study is designed to find the frequency of aspirin resistance (AR) among acute ischemic non-cardioembolic stroke patients, and to assess the clinical picture of those patients. Mehtods: This study included 80 patients39 males and 41 females (mean age: 63 years 11.8 SD), they were diagnosed clinically and via brain imaging within 24 hours following stroke onset. They were given non coated, same preparation of aspirin 150 mg/day regularly and under observation, Low molecular weight heparin 40 mg per day. The patients were followed up clinically and via GCS, NIHSS and APACHEII scales. Assessment of aspirin resistance was done one week after regular aspirin intake through: bleeding time, coagulation time and assessment of thromboxaneA2 level in serum using ELIZA. The patients were classified into two groups aspirin resistant (AR) and aspirin sensitive (AS) and the data were compared in both. Results: AR patients represented 33.75% of our sample. History of TIAs and stroke was more prevalent among them. In AR patients: the followings were also more frequent: more affection of consciousness, power, sensation, language, coordination, vertigo, vomiting, large size of cerebral infarcts, temporal and parietal infarcts. There were high significant negative correlation between GCS and TXA2level and between the later and changes in bleeding time in the first day and 7 days following stroke onset. On the other hand there were high positive correlation between TXA2 level and NIHSS score and infarct size. Coclusion: AR was frequent among ischemic non-cardioembolic stroke and they were associated with history of TIAs and previous strokes, and presented with more severe clinical presentation and larger size of cerebral infarcts, So early identification of AR prevents its fruitless use.

The first-line management for idiopathic trigeminal neuralgia (ITN) is medical therapy. The effectiveness of medications typically wanes over time, so we need to evaluate other modality of therapy. Objective: To compare pharmacotherapy versus Gamma knife radiotherapy (GKRS) in relief of pain in patients with idiopathic trigeminal neuralgia (ITN). Methods: the study included sixty eight patients with idiopathic trigeminal neuralgia. They were assessed by Barrow Neurological Institute (BNI) pain intensity scale. They were classified into two groups: Group I: 34 patients, were treated by GKRS and were chosen from Gamma knife center in Nasser institute hospital. They were 19 (55.9%) male and 15 (44.1%) female with ages ranged from 40-59 years (Mean±SD was 49.5±6.1). They were assessed by BNI scale before and immediately after GKRS, One month and three months after GKRS treatment. Group II: 34 patients, were chosen from neurology department Zagazig University Hospitals. They were 19 (55.9%) male and 15 (44.1%) female with ages ranged from 40-60 years (Mean±SD was 49.0±6.95). They were assessed by BNI scale before and one week after pharmacotherapy, One month and three months after pharmacotherapy. Results: There was no statistically significant difference between the two groups regarding pain intensity before GKRS or pharmacotherapy (p=0.33) while one week after pharmacotherapy ten (29.4%) patients showed statistically significant improvement of pain.After one month, group I showed statistical significant better outcome (41.2%) than group II (8.8%). BNI score three months after managements was highly statisticallly significant better (32.4%) among group I than group II (p=0.001). Most of group I (82.4%) had good overall outcome while 50% of group II had fair outcome and26.5% had good outcome.Conclusion: medical management of ITN had an initial good results in improving pain intensity which begins to wane over one month and the effect of GKRS begins to appear. The effect of GKRS on ITN pain is still evolving through three months follow up.

Transient epileptic amnesia (TEA) may be suspected in patients meeting all of the following criteria: 1) History of recurrent witnessed episodes of transient amnesia; 2) Cognitive functions, excluding memory, judged to be intact during typical episodes by a reliable witness; 3) Documented epilepsy. However, patients who lack a documented diagnosis of epilepsy, may meet the two previous criteria. Such rare and atypical cases, as the one described below, require high clinical suspicion for epilepsy, as well as TEA. Here we describe a rather intriguing case of TEA.