We present an interesting case of acute ischemic stroke in a 26-year-old patient with coronavirus disease 2019, who presented to the hospital initially with headache, vomiting, and right-sided numbness and tingling. The initial workup was negative, including computed tomography (CT) of the head without contrast and CT angiography of the head and neck with no acute abnormalities. The patient was diagnosed with migraine and discharged from the emergency department. The patient developed worsening symptoms at home in the form of increasing right-sided dysmetria and weakness, gait ataxia, and dysarthria, prompting her to return to the emergency room. Magnetic resonance imaging of the brain was performed and was significant for right-sided acute ischemic cerebellar stroke, with also the involvement of the right cerebellar peduncle. Echocardiogram with a bubble study demonstrated patent foramen ovale. The patient was treated with standard guidelines for stroke.

A rare case of anomalous origin of the right coronary artery from the pulmonary artery associated with a large aortopulmonary window in a 4-month-old boy is reported. The right coronary artery is exposed to systemic pressure and carries fairly well-oxygenated blood to the myocardium. Angiographic diagnosis could be difficult because of the simultaneous filling of both great arteries which obscures the origin of the anomalous vessel. Closure of the aortopulmonary window alone could result in acute myocardial ischaemia. A plastic procedure for correction of this association of defects, which should allow normal growth, is described.

Neurological manifestations are common in coronavirus disease 2019 (COVID-19) patients. We present three cases of COVID-19 patients with seizures. Two patients had a history of seizures but very well controlled. They presented with seizure activity likely triggered by COVID-19. The third patient had no history of seizures and presented with new onset of seizure activity. All these patients were routinely screened for COVID-19 on admission and tested positive on nasopharyngeal real-time reverse transcriptase-polymerase chain reaction (rRT-PCR). None of these patients had respiratory symptoms. Electroencephalography (EEG) was abnormal in all three patients. All these patients recovered and were discharged in a stable condition.

Background Although sex disparities in the diagnostic evaluation and revascularization of patients with acute myocardial infarction are well documented, no study has evaluated longitudinal trends in these disparities. Methods and Results Using the National Inpatient Sample from 2005 to 2019, 9 259 932 patients with acute myocardial infarction were identified. We divided 15 years into five 3‐year periods. The primary objective was to evaluate sex‐based trends in the use of diagnostic angiography, percutaneous coronary intervention, and coronary artery bypass graft (CABG) among patients with non–ST‐segment–elevation myocardial infarction and ST‐segment–elevation myocardial infarction (STEMI) over 15 years. The secondary objective was to evaluate sex disparities in mortality, length of stay, and cost. For non–ST‐segment–elevation myocardial infarction, we saw a small reduction in sex disparity in the use of all diagnostic angiography in period 5 versus period 1 (4% versus 5.3%; P <0.01), no change in sex disparity in percutaneous coronary intervention use in period 5 versus period 1 (5.6% versus 5%; P =0.16), and a widening sex disparity in CABG in period 5 versus period 1 (5.4% versus 4.4%; P <0.01). However, we noted decreasing sex disparities in the use of diagnostic angiography, percutaneous coronary intervention, and CABG for ST‐segment–elevation myocardial infarction in mostly all periods compared with period 1 ( P <0.05, all comparisons), but differences still existed in period 5. Risk‐adjusted in‐hospital mortality was higher after CABG for non–ST‐segment–elevation myocardial infarction and after percutaneous coronary intervention and CABG for ST‐segment–elevation myocardial infarction in women than men. Conclusions Despite variable trends in sex disparities in diagnostic and revascularization procedures for acute myocardial infarction, disparities still exist.

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Background Hypertensive crisis is a life-threatening condition, further classified as hypertensive emergency and hypertensive urgency based on the presence or absence of acute or progressive end-organ damage, respectively. Readmissions in hypertensive emergency have been studied before. We aimed to analyze 30-day readmissions using recent data and more specific ICD-10-CM coding in patients with hypertensive crisis. Methods In a retrospective study using the National Readmission Database 2018, we collected data on 129,239 patients admitted with the principal diagnosis of hypertensive crisis. The primary outcome was the all-cause 30-day readmission rate. Secondary outcomes were common causes of readmission, in-hospital mortality, resource utilization, and independent predictors of readmission. We also compared outcomes between patients with hypertensive urgency and hypertensive emergency. Results Among 128,942 patients discharged alive, 13,768 (10.68%) were readmitted within 30 days; the most common cause of readmission was hypertensive crisis (19%). In-hospital mortality for readmissions (1.5%) was higher than for index admissions (0.2%, P&lt;0.01). Mean length of stay for readmissions was 4.5 days. Mean hospital costs associated with readmissions were $10,950, and total hospital costs were $151 million. Age &lt;65 years and female sex were independent predictors of higher readmission rates. Subgroup analysis revealed a higher readmission rate for hypertensive emergency than hypertensive urgency (11.7% vs. 10%, P&lt;0.01). Conclusions All-cause 30-day readmission rates are high in patients admitted with hypertensive crisis, especially patients with hypertensive emergency. Higher in-hospital mortality and resource utilization are associated with readmission in these patients.

Cast Nephropathy/Light chain tubulopathy is usually present in patients with multiple myeloma and is very rare in patients with Waldenstrom Macroglobulinemia. There are very few case reports mentioned in the literature. We present an interesting case of Cast Nephropathy and light chain tubulopathy in an 81-year-old female patient with Waldenstrom Macroglobulinemia who required medical attention for worsening renal failure. Serum protein electrophoresis/Immunofixation showed IgM Kappa monoclonal gammopathy. Renal biopsy was remarkable for cast nephropathy and light chain tubulopathy. Furthermore on bone marrow biopsy a low grade B cell lymphoproliferative disorder with plasmacytic differentiation was present. This was most consistent with lymphoplasmacytic lymphoma, accounting for 50-60 percent of total bone marrow cellularity, in a hypercellular (60-80 percent) bone marrow.

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