Abusing methamphetamine can be considered as an agent that can cause or affect the course of atypical parkinsonian syndromes (APS), which may raise attention regarding preventing abusing these drugs.
Severe acute respiratory syndrome (SARS) coronavirus (COV)-2 causes flu-like symptoms, including fever, cough, fatigue, and loss of sense of smell. Although many complications of this unprecedented virus have been specified, there is still a lack of information on neurologic post-recovery complications. Studies suggest that this rapidly spreading virus can invade the nervous system and cause neurological problems even after recovery. 1 The most common neurological complications include headache, dizziness, myalgia, anosmia, gustatory, and olfactory dysfunctions. 2 Severe disorders such as encephalopathy, encephalitis, necrotizing hemorrhagic encephalopathy, stroke, epileptic seizures, rhabdomyolysis, and Guillain-Barre syndrome have also been reported after coronavirus disease (COVID)-19 infection. 3 There are just six case reports on post-COVID-19 chorea. As far as we know, the two patient cases noted below are the first to be reported with more than a 2-week interval between post-COVID-19 encephalitis and initiation of chorea. [4][5][6][7][8][9][10][11] A 67-year-old woman was referred to the movement disorder clinic because of acute onset of generalized choreiform movements. She stated an earlier admission because of coronavirus symptoms including nausea, loss of appetite, and high blood pressure 3 months prior. Moreover, she tested positive for coronavirus reverse-transcription polymerase chain reaction (RT-PCR) by nasopharyngeal swab. Additionally, 2 weeks after the beginning of her COVID-19 infection, she developed confusion, illusion, aphasia, imbalance, and delirium. Consequently, she was diagnosed with post-COVID-encephalitis and received a tocilizumab injection. She was vaccinateded for COVID-19 (AstraZeneca) 4 months previously. Her family history and previous history of any abnormal movements in any part of her body were negative.She had normal neurological and systemic examinations. However, she was suffering from choreiform movements in her face and all four limbs, with right arm dominancy (Video 1). Brain magnetic resonance imaging (MRI) showed bilateral hyperintensity on fluid-attenuated inversion recovery and T2 imaging on basal ganglia (Fig. 1). She was treated with tetrabenazine (12.5 mg twice daily). After a few days, her symptoms recovered rapidly, and she was discharged.Another 62-year-old otherwise healthy female presented to the movement disorder clinic because she experienced sudden onset abnormal movements in her truncal and limbs. She had been admitted 15 days previously because of her COVID-19 infection and treated with a remdesivir injection. Her past medical history, drug history, and family history were unremarkable. She had no pathological findings in examinations and brain MRI. Nonetheless, she had choreiform movements on her extremities, especially on the right side (Video 2). She was treated with tetrabenazine and chorea dramatically mended.Video 1. Shows the patient with choreiform movements in face and all four limbs, more prominently in the right upper extremity.
After two years of spreading SARS-CoV-2, a well-known virus with respiratory symptoms, the economy, society, and public health were greatly affected. COVID-19 might be life-threatening, and it causes post-infection problems such as neurological complications, which have been reported globally.This virus appears to affect adults more than children, and even neurological complications in adults have been reported more frequently. Although the number of post-COVID neurological problems is rising due to growing cases of COVID-19, there is still a shortage of information about post-COVID-19 movement disorders in young adults and children.Studies suggested that nonspecific neurological conditions such as fatigue, headache, myalgia, and weakness are the most common problems in children affected by COVID-19, and specific neurological complications are uncommon in young adults after recovery from COVID-19. However, these children are at risk of developing seizures, meningeal signs, and encephalopathy, with variable severity. 1 There are also some reports of children with encephalitis 2,3 and acute disseminated encephalomyelitis (ADEM) 4,5 post-COVID-19 infection.Even though ataxia following SARS-CoV-2 infection is reported in adults, [6][7][8] there are just two case reports of APCA after COVID-19 before age 18. 9,10 Ataxia is usually a cerebellar disorder with an acute or chronic presentation. As we mentioned before, ACA is generally a childhood disorder and mostly presents after a recent febrile illness.Herein, we present an immunocompetent young male with acute onset of vertigo and cerebellar ataxia, following coronavirus infection.
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