Faculty Bibliography

We present a case of acute transverse myelitis associated with presumed Covid-19 infection.Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a single-stranded RNA virus that causes coronavirus disease 2019 (COVID-19). The full spectrum of neurological involvement of Covid-19 has not been characterized.Design/Methods: Case report and review of literature.Results: A 52-year-old man from New York City with hypertension, diabetes, and diabetic peripheral neuropathy presented after two days of progressive bilateral leg weakness and urinary retention. He reported fever, cough, and low back pain that started three weeks prior to this presentation. On arrival, he was febrile and hypoxic on room air (SpO2 88%). Neurological examination showed bilateral hip flexion weakness (Medical Research Council grade 3/5), stable length-dependent sensory loss in the lower extremities, and generalized hyporeflexia. Laboratory studies were notable for leukocytosis (15.9 103/uL), lymphopenia (13%), hyponatremia (126 mmol/L), and elevated inflammatory markers: Lactate dehydrogenase (390 IU/L), erythrocyte sedimentation rate (120 mm/hr), C-reactive protein (195 mg/L), and interleukin-2 receptor (1383 pg/mL). Chest radiography revealed interstitial opacities in both lungs. Magnetic resonance imaging of the total spine revealed increased T2 signal in the spinal cord at the level of the T3 vertebra (Figure 1B–D). Cerebrospinal fluid (CSF) analysis revealed normal cell count (1 cell/mL) with elevated protein (91 mg/dL) and negative RT-PCR for SARS-COV-2. Early mobility was encouraged and antipyretics successfully controlled the patient’s fever. Spontaneous voiding returned on day three of hospitalization. His respiratory status also improved, and he was discharged home.Conclusions: Neuroinvasion has been demonstrated to be a common feature of many coronaviruses. This case provides insight into the potential mechanisms by which SARS-CoV-2 can affect the central nervous system, highlights acute transverse myelitis as a neurological manifestation of Covid-19, and demonstrates an example of an affected individual with good potential for neurologic recovery.Disclosure: Dr. Valdes has nothing to disclose. Dr. Zakin has nothing to disclose.

A 38-year-old male presented with a three-week history of bilateral lower extremity choreiform movements. History included sleep abnormalities, rushed and unintelligible speech, with delusions two to six months prior to presentation. He also developed mild dysphagia, staring spells, and anterograde amnesia. On examination, he had pressured speech, asynchronous cycling movements of the bilateral lower extremities persisting during sleep, occasional ballistic movements of the upper extremities, and ataxia. Magnetic resonance imaging (MRI) of the brain showed high cortical signal change in bilateral parieto-occipital cortices with evidence of medullary olive hypertrophy bilaterally. Electroencephalography showed generalized slowing without periodic spikes. Cerebrospinal fluid was positive for protein 14-3-3 and real-time quaking-induced conversion. Genetic testing was positive for autosomal dominant prion protein gene (PRNP) genetic mutation. The patient passed away three months after discharge. This case provides previously undescribed imaging and movement abnormalities in a patient with familial Creutzfeldt-Jakob disease (CJD), and suggests that CJD should not be removed from the differential in patients with these atypical findings.

The COVID-19 pandemic dramatically affected the operations of New York City hospitals during March and April of 2020. This article describes the transformation of a neurology division at a 450-bed tertiary care hospital in a multi-ethnic community in Brooklyn during this initial wave of COVID-19. In lieu of a mass redeployment of staff to internal medicine teams, we report a novel method for a neurology division to participate in a hospital's expansion of care for patients with COVID-19 while maintaining existing team structures and their inherent supervisory and interpersonal support mechanisms.

OBJECTIVES/OBJECTIVE:The objective of this study was to compare safety and efficacy of patent foramen ovale (PFO) closure compared with medical therapy in patients with cryptogenic stroke (CS). BACKGROUND:The role of PFO closure in preventing recurrent stroke in patients with prior CS has been controversial. METHODS:We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials, and the clinical trial registry maintained at clinicaltrials.gov for randomized control trials that compared device closure with medical management and reported on subsequent stroke and adverse events. Event rates were compared using a forest plot of relative risk using a random-effects model assuming interstudy heterogeneity. RESULTS: = 27%, P = 0.002). The presence/absence of atrial septal aneurysm (P = 0.52) had no effect on the outcome. CONCLUSION/CONCLUSIONS:PFO closure is associated with a significant reduction in the risk of stroke compared to medical management. However, it causes an increased risk of atrial fibrillation.