The myotonic dystrophies (DMs) are autosomal dominant disorders, subdivided by their genetic defect into DM1and DM2 and characterized by gradually progressive muscle weakness, myotonia, cataracts, endocrine disturbances and functional abnormalities of the cardiorespiratory and gastrointestinal tract. We report the unusual coexistence of spinal cord meningioma in a patient of myotonic dystrophy. As per our knowledge, this is the second case of a meningioma reported with myotonic dystrophy in the literature.

A 52-year old lady presented with acute onset headache, seizures, confusion and was found to have anemia, albumin/globulin ratio reversal and cerebral venous sinus thrombosis. On further investigations, multiple myeloma was found to be the underlying cause. The patient recovered fully with anticoagulation and chemotherapy. This case indicates that cerebral venous sinus thrombosis can be an unusual presenting manifestation of myeloma.

Background: and Purpose Various neurological findings including stroke in patients with coronavirus disease 2019 (COVID-19) have been described, although no clarity exists regarding the nature and pattern of this association. This systematic review aims to report the characteristics of stroke in patients with COVID-19. Methods: Three authors independently searched Web of Science, Embase, Scopus, and PubMed starting from inception up to May 22, 2020. The data for individual patients was extracted where available from published reports including clinical and laboratory parameters and analysed for any significant associations between variables. Results: We identified 30 relevant articles involving 115 patients with acute or subacute stroke with COVID-19. The mean±standard deviation age was 62.5±14.5 years. Stroke was ischemic in majority of the patients (101 [87.8%]). Hypertension (42 [42%]), dyslipidaemia (24 [26.1%]), and diabetes (23 [23.2%]) were the major vascular risk factors. Most of the patients (80 [85.1%]) had COVID-19 symptoms at the time of stroke with a median interval of 10 days to stroke from the diagnosis of COVID-19. Three-fourths (86 [74.8%]) of the patients were critically ill which frequently delayed the diagnosis of stroke. High levels of D-dimer, and ferritin were observed in these patients. Patients with COVID-19 and stroke had a high mortality (47.9%). Factors associated with mortality were intensive care unit admission, having two or more vascular risk factors, particularly smoking and high levels of D-dimer, C-reactive protein, and lactate dehydrogenase. Conclusions The association between stroke and COVID-19 is probably multifactorial including an amalgamation of traditional vascular risk factors, proinflammatory and a prothrombotic state. Prospectively collected data is required in the future to confirm this hypothesis.