Purpose The purpose of this study was to identify the common clinical presentations and the evidence on the presence of ageusia and anosmia as an emerging coronavirus disease 2019 (COVID-19) symptom to better inform in both COVID-19 patients and clinicians. Patients and Methods As part of a double-institutional collaboration coordinated by doctors, this study retrospectively collected and analyzed the clinical characteristics of 60 patients with COVID-19 pneumonia between April 1 and April 20, 2020. Pregnant women and patients taking anti-cancer drugs had been excluded from the study. Data from each institution’s electronic medical record had been obtained. Results Sixty patients who had RT-PCR positive for COVID-19 were included in this study; of these patients, all of them had unknown exposure to COVID-19. The mean (SD) age was 45.7 (13.5) years, and 42 were men (70%). Of these patients, 80% had at least ageusia or anosmia. The most common symptoms at the onset of illness were cough (75%), fever (71.3%), myalgia or fatigue (53.3%), anosmia (loss of smell) (40%), ageusia (loss of taste) (28.3%), sore throat (25%), shortness of breath (16.7%), headache (16.7%), and GI symptoms (diarrhea, nausea, vomiting and loss appetite) (16.7%). A total of 68.3% of COVID-19 infected patients had reported either loss of taste or smell, and about 33.3% of them had only loss of smell, while 23.3% of them had impaired taste, and 11.7% of COVID-19 infected patients had both taste and smell loss. Conclusion During the epidemic period of SARS-CoV-2 infection, when presenting patients with ageusia and anosmia, physicians should consider COVID-19 pneumonia as a differential diagnosis to achieve early identification, avoid the delayed diagnosis, and prevention of transmission.

INTRODUCTION:Basic in Somali. a country in East Africa, no data are available about key features of stroke such as incidence, prevalence, and mortality or stroke subtypes. So. we decided to conduct this study to make sure the rate burden of stroke in our population and become a starting data for further research.MATERIALS AND METHODSWe performed a retrospective hospital-based study in Mogadishu, Somali, to assess risk factors and etiology of stroke. Patients were recruited from January 1, 2019, to December 31, 2019, at the MogadishuSomali–Turkey Recep Tayyip Erdoğan Training and Research Hospital.RESULTSA total of 292 participants with stroke (65.4% male and 34.6% women) were analyzed. The prevalence of Ischemic and Hemorrhagic Strokes were 66.8% and 33.2% respectively. A system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment (TOAST)[7], the most prevalent were stroke of other determined etiology (28.7%), undetermined (24.6%) and large artery disease (22.1%) while the least common ischemic strokes were lunar stroke (11.3%) and cardio embolic (13.3%). The most prevalent hemorrhagic strokes were Basal ganglia CONCLUSIONS: In Somalia there is no previous data for the prevalence and risk factors of the stroke. We concluded that the prevalence of hemorrhagic stroke in Somalia is more compared than the other countries (from 20% worldwide to 33.2% Somali). And the most risk factors were hypertension and diabetes mellitus.

Key Clinical Message Bilateral thalamic infarction in paramedian artery territory may present with severe acute illness, confusion, coma and memory impairment. However, subtle clinical presentation as in our case should alert the clinician to consider such a diagnosis as it can be associated with good prognosis. Abstract Bilateral thalamic infarct is a rare form of stroke. Mostly thalamic infarcts are unilateral. In most cases, bilateral thalamic infarction leads to cognitive dysfunction, opthalmoparesis, conscious impairment, behavioral disturbance, and corticospinal dysfunction. Here, we describe the case of a 75‐year‐old male patient who presented to the emergency department of our hospital with agitation and somnolence for one day. He had poorly controlled hypertension. There was no previous history of stroke, diabetes mellitus, hyperlipidemia, known cardiac disease, or smoking history. There was no seizure, recent headache, or visual disturbance. The patient was somnolent and not oriented to time, person, or place. Neurological examination did not show any focal weakness or vertical eye movement restrictions. Other systemic examinations, including those of the respiratory and cardiovascular systems, were unremarkable. Extensive laboratory investigations excluded potential metabolic, infectious, endocrine, or toxic etiologies. The patient did not have any recent history of drug misuse, including benzodiazepines. Brain MRI with diffusion‐weighted imaging showed an acute bilateral thalamic infarct. Cerebral angiography was unremarkable. The patient was treated with low molecular weight heparin 60 mg subcutaneously, aspirin 300 mg daily, and haloperidol 5 mg twice daily for agitation. After two weeks of intrahospital treatment, his condition improved (consciousness and orientation massively improved).

Introduction and Importance: Lateral medullary syndrome (LMS) is a less common form of a brainstem stroke. It is the result of occlusion of the posterior inferior cerebellar artery (PICA). It is caused by atherosclerosis, thrombosis, or emboli from another source. Case Presentation: A 60-year-old male patient presented to the emergency department with vertigo, vomiting, slurred speech, hiccups, and left-side weakness associated with paresthesia for 1 day. He had a past medical history of uncontrolled hypertension and a smoking habit. The neurological examination revealed ataxia, and left hemiparesis associated with paresthesia. A cranial nerve examination revealed slight right-sided ptosis, mouth deviation, and loss of sensory sensation on the right side of the face. Brain MRI showed right medullary infarct consistent with LMS. Electrocardiogram, echocardiography, and vertebral artery color Doppler were normal. He was admitted to the neurology ward and was treated with low molecular weight heparin 60 mg subcutaneously, aspirin 300 mg, neuroprotective agents, and antihypertensive treatment. After 6 days of medical treatment, his condition has improved massively (dysarthria and dysphagia disappeared). He was discharged for physical rehabilitation. Clinical Discussion: LMS (Wallenberg syndrome) is one of the brainstem stroke syndromes caused by occlusion of PICA. Vertigo, vomiting, dysphagia, dysarthria, ipsilateral ataxia, Horner’s syndrome, and contralateral hemiparesis define this syndrome. Brain MRI is necessary for diagnosis alongside clinical syndrome. Conclusion: LMS is a rare form of brainstem stroke and carries a favorable prognosis if early hospitalization and treatment is applied. Brain MRI, including diffusion sequence, is the most useful diagnostic tool for detecting LMS.

Introduction and importance: Lateral medullary syndrome (LMS) is less common form of brainstem stroke. It is the result of occlusion of posterior inferior cerebellar artery (PICA). It is caused by atherosclerosis, thrombosis or emboli from another source. Case Presentation: A 60-year-old male patient presented to the emergency department with vertigo, vomiting, slurred speech, hiccups, and right side weakness associated with parasthesia for one day. He had past medical history of uncontrolled hypertension, and a smoking habit. The neurological examination revealed ataxia, right hemiparesis associated with parasthesia. Cranial nerve examination revealed right-sided slight ptosis, mouth deviation, and loss of sensory sensation on the right side of the face. Brain MRI showed right medullary infract consistent with lateral medullary syndrome. Electrocardiogram, echocardiography and vertebral artery color Doppler were normal. He was admitted to the neurology ward and was treated with Clexane 60mg SC, Aspirin 300 mg, neuroprotective agents, and antihypertensive treatment. After 6 days of medical treatment, his condition has improved massively (dysarthria and dysphagia disappeared). He was discharged for physical rehabilitation. Clinical discussion: Lateral medullary syndrome (Wallenberg syndrome) is one of the brainstem stroke syndrome caused by occlusion of PICA. Vertigo, vomiting, dysphagia, dysarthria, ipsilateral ataxia, Horner syndrome and contralateral hemiparesis define this syndrome. Brain MRI is necessary for diagnosis alongside the clinical syndrome. Conclusion LMS is rare form of brainstem stroke and carries favorable prognosis if early hospitalization and treatment is applied. Brain MRI including diffusion sequence is the most useful diagnostic tool for detecting LMS.

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