Coronavirus disease 2019 (COVID-19) pandemic is caused by the severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and since the outbreak, many neurological features and syndromes are reported with this multi-organ viral infection. Lance-Adams syndrome (LAS) also referred to as chronic post hypoxic myoclonus is defined as action myoclonus which can occur as generalized, focal, or multifocal repeated myoclonic motor movements which involve the face, trunk, or extremities and it is one of the neurological complications that are related to COVID-19 infection. LAS is reported as a delayed complication of cardiac arrest, which causes cerebral hypoxia leading to myoclonus. We report a case of a 58-year-old male patient diagnosed as a case of LAS secondary to hypoxia occurring because of COVID-19 without cardiac arrest and to the best of our knowledge it is the second case reported with this similar mechanism. Moreover, we discuss the possible pathophysiological relationship between LAS and COVID-19 and various treatment strategies. Eventually, we review the related articles in the literature regarding the LAS and various types of myoclonus associated with COVID-19 infection.

Introduction: COVID-19 disease is currently pandemic, and its prevalence in Saudi Arabia is concerning. The SARS-CoV-2 virus primarily affects the lungs, but it also affects the haematopoietic system. The atypical lymphocytes on peripheral blood film that have a distinct morphological appearance were of particular interest in this study. Our goal was to see a link between atypical lymphocytes and COVID-19 patient mortality. Methods: This four-month single-centered prospective descriptive study was conducted in Makkah, Saudi Arabia. COVID-19 patients of both genders were randomly selected based on inclusion criteria. The data from the patient’s electronic medical record was extracted. All patients’ peripheral blood film parameters were recorded on days 3, 7, and 14 after admission. The statistical data was analysed using SPSS version 23. The Fisher’s exact test was used to determine the relationship with mortality. A p value of 0.05 was considered significant. Results: The total number of cases enrolled in the study was 226. The patients’ average age was 58 years (SD 0.5289). On the third day of admission, 88.2 % of patients with COVID-19 had atypical lymphocytes, with a mean of 2.35 ± 0.927. A significant correlation (p < 0.001) exists between atypical lymphocytes decreasing percentage number on the 3rd, 7th, and 14th days of admission and death. Conclusion: The decrease in the number of atypical lymphocytes on peripheral blood film has a significant association with the patients’ mortality. This fact can be used to develop a tailored management strategy based on the observation of peripheral blood film.

Perampanel (Fycompa) is a glutamate receptor antagonist known to be a safe, effective, and well-tolerated medication; nevertheless, adverse effects are possible. This case report aims to raise the suspicion of perampanel-induced thrombocytopenia and discuss its possible pathways implicated.Here, we present the case of a 66-year-old female patient with a generalized tonic-clonic seizure initially managed with levetiracetam, valproic acid, and lacosamide; however, the patient continued to have seizures clinically as well as on the electroencephalogram. The patient was initiated on 2 mg of perampanel and reached up to 12 mg within a week, after which the seizure was controlled. Nevertheless, after perampanel initiation, a gradual platelet count reduction was observed. Upon withdrawal of perampanel, the platelet count dramatically improved reaching up to her baseline.Although perampanel is known to be a safe medication, a hematological complication such as thrombocytopenia is possible. The exact mechanism remains unclear. Further studies are required to understand the association between thrombocytopenia and perampanel to identify high-risk populations and prevent this condition sequentially.

Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS). It has many types, which include tumefactive multiple sclerosis (TMS), one of the most uncommon types. We present the case of a 36year-old woman who presented with right-sided numbness of the body. Magnetic resonance imaging (MRI) of the brain revealed a large mass (3 cm × 2.5 cm) in the deep white matter of the right frontal lobe along with smaller lesions of variable sizes. After considering the MRI features, the CSF results, and the improvement of the symptoms with a high dose of steroids, the diagnosis of tumefactive multiple sclerosis was made. A biopsy was not done on our patient as the symptoms resolved after treatment, although sometimes it is necessary for diagnosing tumefactive multiple sclerosis to rule out tumors or abscesses. The current study described the clinical presentation, the role of imaging, the differential diagnosis, and the treatment options. This case report aimed to report a rare presentation of TMS, which highlights the importance of differentiating TMS from other space-occupying lesions for prompt and proper management.

Background Human brucellosis is an infectious multisystem disease that varies in severity and clinical course. Bacteremia in brucellosis is common; however, data on epidemiology and management of Brucella bacteremia are scarce. The World Health Organization recommends using doxycycline with rifampicin or an aminoglycoside for brucellosis. This study aims to compare the efficacy of the two treatment regimens (oral doxycycline/rifampicin or ciprofloxacin versus IV gentamicin plus oral doxycycline/rifampicin or ciprofloxacin) in Brucella bacteremia. Methods In this single-center, retrospective cohort study, we analyzed the outcomes of 93 adults with confirmed Brucella bacteremia from 2017 to 2020. The diagnosis of brucellosis was based on positive blood culture for Brucella species. The patients were divided into two cohorts according to the treatment regimen received (oral versus IV). Blood culture negativity after four weeks and clinical cure rate at end of therapy were the co-primary endpoints, while side effects were secondary endpoints. Fisher's exact test and Pearson's chi-square test were applied to compare the two groups. The data were analyzed using SPSS version 23. A P-value &lt; .05 was considered significant. Results A total of 93 cases of Brucella bacteremia were enrolled, with 64 (68.8%) patients being male, and the group mean age being 44.3 ± 19.2 years. Overall, 37 (39.8%) patients received IV regimen, while 56 (60.2%) received oral treatment. Follow-up blood culture negativity after four weeks for both groups was 90.3% (n=84) with no difference between the oral and IV regimens (87.5% (n=49) versus 94.6% (n=37); P= .348, respectively). The overall clinical cure rate was 93.5% (n=87) for both groups combined, with no significant difference between the oral and IV groups (91% (n=51) versus 97.3% (n=36); P= .397, respectively). Transaminitis (7.1% vs. 5.4%), vomiting (5.4% vs. 8.1%), and acute kidney injury (0% vs. 2.7%) were all reported in the oral and IV groups, respectively, with no statistically significant difference between the two groups (P =.590). No deaths were reported over this period. Conclusion Oral and IV antimicrobial regimens have the same response rates in Brucella bacteremia patients. Disclosures All Authors: No reported disclosures.