The SARS-CoV-2 virus causing Coronavirus Disease 2019 (COVID-19) is a global pandemic with almost 30 million confirmed worldwide cases. Prothrombotic complications arising from those affected with severe symptoms have been reported in various medical journals. Currently, clinical trials are underway to address the questions regarding anticoagulation dosing strategies to prevent thrombosis for these critically ill patients. However, given the increasing use of therapeutic anticoagulation in patients admitted with COVID-19 to curtail this prothrombotic state, our institution has witnessed six cases of devastating intracranial hemorrhage as well as thrombosis leading to five fatalities and we examine their hospital course and anticoagulation used.

Objective Monkeypox virus (MPXV) disease has been declared a public health emergency by the World Health Organization, creating an urgent need for neurologists to be able to recognize, diagnosis, and treat MPXV‐associated neurologic disease. Methods Three cases of MPXV‐associated central nervous system (CNS) disease occurring during the 2022 outbreak, and their associated imaging findings are presented, with 2 cases previously published in a limited capacity in a public health bulletin. Results Three previously healthy immunocompetent gay men in their 30s developed a febrile illness followed by progressive neurologic symptoms with presence of a vesiculopustular rash. MPXV nucleic acid was detected by polymerase chain reaction (PCR) from skin lesions of 2 patients, with the third patient having indeterminate testing but an epidemiologic link to a confirmed MPXV disease case. Cerebrospinal fluid demonstrated a lymphocytic pleocytosis, elevated protein, and negative MPXV‐specific PCR. In 2 patients, magnetic resonance imaging of the brain and spine demonstrated partially enhancing, longitudinally extensive central spinal cord lesions with multifocal subcortical, basal ganglia, thalamic, cerebellar, and/or brainstem lesions. The third patient had thalamic and basal ganglia lesions. All patients received 14 days of tecovirimat, and 2 patients also received multiple forms of immunotherapy, including intravenous immunoglobulin, pulsed high‐dose steroids, plasmapheresis, and/or rituximab. Good neurologic recovery was observed in all cases. Interpretation MPXV can be associated with CNS disease. It is unclear whether this is from a parainfectious immune‐mediated injury or direct CNS viral invasion. ANN NEUROL 2023;93:893–905

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Background: Current guidelines for the management of acute ischemic stroke (IS) in 2021, and intracerebral hemorrhage (ICH) in 2015 recommend toxicology (TOX) screens to detect cocaine and other sympathomimetic drugs of abuse without discrimination by race/ethnicity or socioeconomic status. Retrospective studies have demonstrated bias, however, on drug screening of young African-American ICH patients despite current guidelines. We sought to explore our current screens use for both IS and ICH patients to discover if there was any bias in our clinical practices. Methods: A single center retrospective review of electronic medical records between January 1 st 2018-Dec 31 st 2019. With the following diagnosis; IS, transient ischemic attack (TIA), ICH, and subarachnoid hemorrhage We recorded demographic data; age, gender, race/ethnicity, insurance status, cardiovascular comorbidities, drug and alcohol screen. We present data with descriptive statistics with plans for covariant analyses Results: We reviewed 725 patient charts. There were 406 (56%) white, 161 (23%) African American, 90 (12%)Hispanic and 66 (9%)other race/ethnicities. There was 146/725 (20%) tox screens ordered. Distributed by race; 61/408(15%) white, 56/161 (35%), African-Americans 20/90 (23%) Hispanic and 8/166 (12%) others had tox screens. Tox was ordered in 75/373 (20%) males and 71/352 (20%) females. By insurance status, patients with tox screens had predominantly Medicaid (44%) or no-insurance (30%). Tox screens was ordered on 31% of those <55 yo and tox screen was ordered on 17% >55 yo. There was 483/725 (66%) IS or TIA and 242/725 (33%) ICH. Tox screen was ordered on 82/483 (17%) IS and 65/242 (27%) ICH Conclusion: At our center, there appears to be unintended ethnic and/or economic bias in ordering toxicology screens both for ICH and IS. Awareness of implicit bias and better standardization in care processes for evaluation of drug and alcohol use in ischemic and hemorrhagic stroke patients is essential.