Objective: Neurological emergencies saw a paradigm shift in approach during the coronavirus disease-2019 (COVID-19) pandemic with the challenge to manage patients with and without COVID-19. We aimed to compare the various neurological disorders and 3 months outcome in patients with and without SARS-CoV-2 infection. Methods: In an ambispective cohort study design, we enrolled patients with and without SARS CoV-2 infection coming to a medical emergency with neurological disorders between April 2020 and September 2020. Demographic, clinical, biochemical, and treatment details of these patients were collected and compared. Their outcomes, both in-hospital and at 3 months were assessed by the modified Rankin Scale (mRS). Results: Two thirty-five patients (235) were enrolled from emergency services with neurological disorders. Of them, 81 (34.5%) were COVID-19 positive. The mean (SD) age was 49.5 (17.3) years, and the majority of the patients were male (63.0%). The commonest neurological diagnosis was acute ischemic stroke (AIS) (43.0%). The in-hospital mortality was higher in the patients who were COVID-19 positive (COVID-19 positive: 29 (35.8%) versus COVID-19 negative: 12 (7.8%), P value: <0.001). The 3 months telephonic follow-up could be completed in 73.2% of the patients (142/194). Four (12.1%) deaths occurred on follow-up in the COVID-19 positive versus fifteen (13.8%) in the COVID-19 negative patients (P value: 1.00). The 3-month mRS was worse in the COVID-19 positive group (P value <0.001). However, this was driven by higher in-hospital morbidity and mortality in COVID-19 positive patients. Conclusion: Patients with neurological disorders presenting with COVID-19 infection had worse outcomes, including in-hospital and 3 months disability.

The pharyngeal-cervical-brachial (PCB) variant is a rare presentation of Guillain–Barré syndrome (GBS), and there is a handful of case reports that overlap with the Miller–Fisher syndrome (MFS) variant of GBS. This overlap produces varied symptoms that may be confusing and challenging for physicians to diagnose timely and start appropriate treatment. In this article, we present a case report and review of the rare overlap of the PCB variant with the MFS variant of GBS.

Methylenetetrahydrofolate reductase ( MTHFR ) deficiency is a rare autosomal-recessive disorder of folate metabolism, presenting with neurological symptoms such as spastic paraparesis, cognitive impairment, and psychosis. We report a 25-year-old male who developed progressive spastic paraparesis over nine months, requiring assistance to walk. Neurological examination revealed increased tone, brisk reflexes, and sensory deficits. Brain MRI showed cerebral atrophy with white matter hyperintensities, and fasting homocysteine levels were elevated (143.01 µmol/L). Whole exome sequencing identified a homozygous mutation in the MTHFR gene, confirming the diagnosis of hyperhomocysteinemia. The patient was treated with high-dose vitamin B12, folate, and pyridoxine supplementation, resulting in mild improvement in spasticity and walking after one month. This case highlights the importance of considering MTHFR deficiency in young adults with unexplained spastic paraparesis and cognitive or psychiatric symptoms. Elevated homocysteine levels and genetic testing are crucial for diagnosis, and early treatment can improve clinical outcomes.