Introduction: Multiple risk factors of mortality have been identified in patients with COVID-19. Here, we sought to determine the effect of a history of neurological disorder and development of neurological manifestations on mortality in hospitalized patients with COVID-19.Methods: From March 20 to May 20, 2020, hospitalized patients with laboratory confirmed or highly suspected COVID-19 were identified at four hospitals in Ohio. Previous history of neurological disease was classified by severity (major or minor). Neurological manifestations during disease course were also grouped into major and minor manifestations. Encephalopathy, ischemic or hemorrhagic stroke, and seizures were defined as major manifestations, whereas minor neurological manifestations included headache, anosmia, dysgeusia, dizziness or vertigo, and myalgias. Multivariate logistic regression models were used to determine significant predictors of mortality in patients with COVID-19 infection.Results: 574/626 hospitalized patients were eligible for inclusion. Mean age of the 574 patients included in the analysis was 62.8 (SD 17.6), with 298 (51.9%) women. Of the cohort, 240(41.8%) patients had a prior history of neurological disease (HND), of which 204 (35.5%) had a major history of neurological disease (HND). Mortality rates were higher in patients with a major HND (30.9 vs. 15.4%; p = 0.00002), although this was not a significant predictor of death. Major neurological manifestations were recorded in 203/574 (35.4%) patients during disease course. The mortality rate in patients who had major neurological manifestations was 37.4% compared to 11.9% (p = 2 × 10 −12 ) in those who did not. In multivariate analysis, major neurological manifestation (OR 2.1,; p = 0.002) was a predictor of death. Conclusions: In this retrospective study, history of pre-existing neurological disease in hospitalized COVID-19 patients did not impact mortality; however, development of major neurological manifestations during disease course was found to be an independent predictor of death. Larger studies are needed to validate our findings.

The competency-based model has been guiding medical education on an international level over the last decades [1]. This model is learner-centered and has mastery of specific knowledge and skills as its unit of progression [2]. In the realm of electroencephalography (EEG), there have been continued efforts to ensure that residents have the competence to accurately and reliably interpret EEGs by the time they complete residency training. Achieving this goal is imperative, especially in countries where EEGs are typically read by neurologists without clinical neurophysiology or epilepsy fellowship training [3,4], due to the deleterious consequences of EEG misinterpretation and epilepsy misdiagnosis [3]. In an attempt to define minimum EEG competency milestones, we herein propose a prioritized list of routine EEG findings that all adult and child neurology residents should be able to identify and interpret on completion of training. Resident EEG education is guided by well-formulated milestones proposed by organizations such as the Accreditation Council for Graduate Medical Education (ACGME) [5] and International League Against Epilepsy (ILAE) [6]. These milestones, however, are not meant to be used to determine whether a trainee is competent to graduate; additionally, the milestones do not specify particular EEG findings that should be mastered by trainees. For example, the ACGME EEG Level 3 milestone encapsulates recognition of "common EEG abnormalities"; these "abnormalities", nonetheless, are not specified. We surveyed a group of EEG/epilepsy experts to delineate a list of routine EEG findings rated by their clinical yield for adult and child neurology resident education. The authors (FN, JJ, MBW, SB) designed an online survey (see supplementary material) in which a comprehensive set of adult and pediatric routine EEG findings were listed under four major sections: normal findings, artifacts, normal variants, and abnormal findings. Neonatal EEG findings were not included. EEG/epilepsy experts were asked to rate each EEG finding on a 5-point Likert rating scale (1 = "not

Glomus tumor is an exceedingly rare neoplasm that is derived from cells of the neuromyoarterial glomus or glomus body. It rarely occurs in the visceral organs where glomus body may be sparse or even absent, such as the stomach, intestines, mediastinum, and respiratory tract. It is unusual for a glomus tumor to demonstrate atypical or malignant histopathological characteristics. It is also rare for such a tumor to express clinically aggressive behavior. However, when metastasis does occur, this disease is often fatal. We herein report an interesting case of a middle-age woman admitted due to progressive cough and hemoptysis. A polypoid mass was found to occlude the left lingular lobar bronchus. Final histopathologic examination showed the presence of malignant glomus tumor, confirmed by immunoreactivity for smooth muscle actin and vimentin. Two months later, the patient developed abdominal distension and gastrointestinal bleeding. Further evaluation lead to the discovery of widespread metastatic disease to the gastrointestinal tract, spleen, and the left adrenal gland. We further entail a review of the literature on the clinicopathologic features and diagnosis of this uncommon tumor.

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This study was conducted to examine the relationship between metacognitive awareness of reading strategies (MARS), and academic attainments (AA) of undergraduate business students. It also investigated the relationship between reading practices (RP) and MARS. There are three different categories of MARS-global, problem solving, and support reading strategies. The Metacognitive Awareness of Reading Strategies Inventory (MARSI), developed by Mokhtari and Reichard (2002) was used as the instrument for this study where the sample consisted of 571 male and female students of undergraduate business program from private and public universities of Karachi. The results showed Metacognitive Awareness of Reading Strategies significantly predicts academic attainments of university students. The findings suggest that conducting workshops or training sessions for promoting MARS may be helpful to enhance students' concentration towards the reading process that may affect their learning.

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Periodic discharges seen in patients undergoing continuous EEG pose a challenge to physicians in falling into the interictal-ictal continuum and need for appropriate diagnostic and management approach. The authors herein present an 83-year-old male patient with an acute subdural hematoma who developed intermittent right upper and lower extremity weakness with change in mental status post craniotomy and hematoma evacuation. The patient was intubated and sedated with midazolam and propofol and placed on anti-seizure medications to control seizures. He was placed on continuous EEG monitoring and later developed lateralized periodic discharges. To guide treatment, a computed tomography perfusion study of the brain was performed. The results were consistent with an ictal phenomenon because of the presence of left hemispheric hyperemia. This increased cerebral blood volume and blood flow was used as a diagnostic tool to warrant more aggressive antiepileptic regimen. The patient was then started on an additional anti-seizure medication and dosages were further optimized. This led to an improvement in the patient's EEG and clinical state. There are numerous studies that show lateralized periodic discharges are seen as examples of subclinical status epilepticus and demonstrate hypermetabolism and hyperemia on positron emission tomography and single-photon emission computed tomography scans. When such imaging modalities are unavailable, cortical hyperperfusion on a computed tomography perfusion study might be a valid predictor of ongoing, subclinical, ictal activity and may be used as a complementary diagnostic tool to EEG to guide treatment.

Case series Patients: Male, 34-year-old • Female, 57-year-old Final Diagnosis: West Nile virus myeloradiculitis • West Nile virus opsoclonus myoclonus ataxia syndrome Symptoms: Confusion • lower extremity weakness • opsoclonus-myoclonus-ataxia Medication: — Clinical Procedure: Lumbar puncture Specialty: Infectious Diseases • Neurology Objective: Unusual clinical course Background: West Nile virus (WNv) is the leading cause of epidemic arbovirus encephalitis in the continental United States. Movement disorders (MDs) have been reported in 20% to 40% of patients with WNv and about 37% of patients with WNv encephalitis have changes on magnetic resonance imaging (MRI). We report 2 unusual cases of neuroinvasive WNv in patients with unusual MDs and unreported MRI findings. Case Reports: In the first case, a 34-year-old man presented with a 1-week history of disinhibition, agitation, opsoclonus-myoclonus and ataxia syndrome (OMAS), tremor, and facial agnosia. Evaluation of his cerebrospinal fluid (CSF) revealed elevated immunoglobulin (Ig)M against WNv, a high level of protein (98 mg/dL), and an elevated white blood cell (WBC) count (134, 37% lymphocytes). An MRI of the brain showed an area of diffusion restriction in the splenium of the corpus callosum . The patient’s MRI findings and OMA improved significantly after 2 treatments with i.v. IG (IVIG). In the second case, a 57-year-old woman presented with fever, headaches, psychosis, and ataxia; she was subsequently intubated for airway protection. Analysis of her CSF showed elevated IgM against WNv, a high level of protein (79 mg/dL), and elevated WBC count (106, 90% lymphocytes). One week after the onset of symptoms, the patient experienced facial dyskinesia. Later, she developed proximal bilateral lower extremity weakness. An MRI of her lumbar spine showed evidence of myeloradiculitis with contrast enhancement of the conus medullaris and ventral nerve roots. After a single treatment with IVIG, she had partial improvement in weakness. Conclusions: MDs and changes on MRI have been reported in patients with neuroinvasive WNv disease. Our patient with OMAS also had transient splenial diffusion restriction on imaging, which, to the best of our knowledge, has not been previously reported with WNv infection. In both patients, treatment with IVIG resulted in improvement in symptoms.