Highlights We described GBS symptoms in three infected patients with COVID-19. The severity and fast progression of GBS linked to COVID-19 seems considerable in mentioned cases. Acute motor and sensory axonal neuropathy (AMSAN) type of GBS was diagnosed according to electrodiagnostic findings in all three cases. GBS is suggested to be considered as a severe and rapid progressive profile in neurologic complications of COVID-19.

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We visited a 57-year-old man with horizontal diplopia. His problems had started 5 years earlier with progressive gait disturbance followed by falling backward, low-tone speech, and drooling. He was also suffering from binocular nonfluctuating diplopia since the previous year. Examination revealed bilateral exotropia on primary position with very slow saccadic movements. Vertical eye movements were severely limited. On horizontal movements, he had severe limited adduction of both eyes with nystagmus on the abducting eye. These abnormalities could be overcome by oculocephalic maneuver. The convergence was also impaired (Video S1). In addition, there was slowness of all movements and severe postural instability on the pull test (Video S2).Which of the following is a better explanation of eye movement abnormalities in this progressive supranuclear palsy (PSP) patient?A. Coincidental ocular myasthenia B. Coincidental internuclear ophthalmoplegia as a result of a structural lesion C. Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) as an ocular finding in PSP Answer C. WEBINO as an ocular finding in PSP. Parkinsonism with recurrent backward falls, vertical supranuclear gaze palsy, and a typical humming-bird sign on brain MRI (Supplementary Figure S1) are highly suggestive of PSP. Brain magnetic resonance imaging did not show any other structural lesion to explain the diplopia and abnormal eye movements. To rule out accompanying myasthenia, single-fiber electromyography and serum levels of antiacethylcholine receptor and anti-muscle specific tyrosine kinase antibodies were checked, and all of them were normal. We concluded that diplopia and abnormal horizontal eye movements in this case are compatible with WEBINO. WEBINO is a rare neurological syndrome characterized by exotropia in the primary gaze, limited adduction of the eyes, and convergence impairment. It is usually attributed to lesions of mesencephalic tegmentum involving medial longitudinal fasciculi or exaggerated excitation of both paramedian pontine reticular formation. [1][2][3] In addition to supranuclear gaze palsy, other eye movement abnormalities reported in PSP include lid retraction, square wave jerks, lid opening apraxia, and blepharospasm and rarely internuclear ophthalmoplegia and WEBINO. 1-3

10.30699/jambs.28.131.296 Background & Objective: The blink reflex recovery cycle indicates the excitability of interneurons in the brainstem. In this study, we aimed to investigate the blink reflex and R2 recovery cycle in patients with benign essential blepharospasm (BEB). Materials & Methods: This prospective case-control study compared the blink reflex and R2 recovery in 18 BEB patients with 18 age-and gender-matched healthy individuals. The blink reflex was measured in a stimulation duration of 0.2 ms, and R1, R2, and R2' were recorded for all subjects. The R2 recovery cycle was measured by stimulation of the supraorbital nerve at four interstimulus intervals (ISI) of 200, 300, 500, and 1000 ms, with the same intensity as the previous test. The R2 recovery index was calculated and compared with the control group via independent sample ttest. Two-tailed P-value less than 0.05 was considered statistically significant. Results: The blink reflex (R1, R2, and R2' responses) distal latencies and amplitudes in the BEB group were not significantly different from the control group (P>0.05). The R2 recovery index in all intervals was significantly higher in the BEB group than the control group (P=0.00). The most significant difference between the BEB and control groups regarding the R2 recovery indices was observed at ISIs of 300 and 200 ms (80.36 vs. 16.99 and 75.70 vs. 12.57, respectively). There was a negative correlation between the patient's age at the onset of disease and the R2 recovery index; however, it was not statistically significant (P>0.05). Conclusion: Our findings showed that the R2 recovery reflex was higher in BEB patients than the normal population. Therefore, it can be a helpful index for differentiating BEB cases from psychogenic or malingering ones.

Background: Considering the high prevalence of vitamin D deficiency worldwide and its relationship with immune response to viral infections, this study attempted to identify the predictive power of serum vitamin D for poor outcomes among the COVID-19 patients.Methods: This retrospective cohort study included all patients with confirmed COVID-19 hospitalized between 20 February 2020 and 20 April 2020 at a designated COVID-19 hospital, located in Tehran province, Iran. General characteristics, medical history, and clinical symptoms were recorded by trained physicians. Blood parameters including complete blood count, creatinine, lactate dehydrogenase, creatine phosphokinase, erythrocyte sedimentation rate, C-reactive protein, and vitamin D were tested. Results: This study included 290 hospitalized patients with COVID-19 (the mean age (SD): 61.6 (16.9), 56.6% males), of whom 142 had vitamin D concentrations less than 20 ng/ml, defined as vitamin D deficiency. COVID-19 patients with vitamin D deficiency were more likely to die (Crude OR (95% CI): 2.30 (1.25-4.26)), require ICU care (2.06 (1.22-3.46)) and invasive mechanical ventilation (2.03 (1.04-3.93)) based on univariate logistic regression results. However, after adjusting for potentials confounders such as gender and age, the association between vitamin D and need to invasive mechanical ventilation lost its significance.Conclusion: Vitamin D deficiency can be considered as a predictor of poor outcomes and mortality in COVID-19 patients. Therefore, checking serum 25 (OH) D on admission and taking vitamin D supplements according to the prophylactic or treatment protocols is recommended for all COVID-19 patients.