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Abstract The use of ivermectin for the treatment of COVID-19 infections has been a subject of significant interest and controversy. The drug has a history of off-label use for a variety of clinical disorders and has shown some potential as an antiviral drug in in vitro studies and animal studies, and it has a relatively favorable safety profile. Multiple studies have been published examining the use of ivermectin against COVID-19. While several studies suggested it could be an effective therapeutic, most of these studies were insufficiently robust, had design flaws, or did not report any changes in important clinical outcomes, such as mortality. A smaller number of more robust studies did not support ivermectin use for COVID-19 treatment. Therefore, at present, ivermectin cannot be recommended for the treatment of COVID-19. While further studies may be warranted, this decision must be weighed against the possibility that this research may not alter current recommendations on the use of ivermectin in COVID-19 infections.    Keywords: COVID-19; ivermectin; prophylaxis, hospitalization, respiratory failure, mortality

The case describes an 82-year-old right-handed Hispanic male with multiple chronic comorbidities complaining of upper and lower extremity weakness as well as paresthesias that had been worsening over the last two weeks. He had bilateral upper and lower extremity weakness that was worse on the right and he complained of not being able to walk on his own with several falls preceding admission because of this. There were no overt signs of spinal cord compression or cauda equina syndrome. Laboratory work-up was unremarkable with exception to mildly elevated acute phase reactants. Computed tomography (CT) and magnetic resonance (MR) imaging later showed critical cervical compressive myelopathy at the C3-C4 level and multiple parenchymal and extra-axial enhancing lesions in the frontal lobes with associated calcifications suspicious for neurocysticercosis. Antihelminthic therapy was started and the patient underwent spinal fusion surgery with neurosurgery with an uncomplicated postoperative course-also lacking seizure activity of any kind.