Frequently the cause of raised intracranial pressure remains unresolved and rarely is related to spinal tumours, moreover less to spinal medulloblastoma without primary brain focus. An 18-year-old woman had a 3-month history of headache and impaired vision. Neurological examination revealed bilateral sixth cranial nerve palsies with bilateral papilloedema of grade III. No focal brain or spine lesion was found on imaging. Consecutive lumbar punctures showed high opening pressure and subsequent increasing protein level. Meningeal biopsy was negative. At one point, she developed an increasing headache, vomiting and back pain. Spine MRI showed diffuse nodular leptomeningeal enhancement with the largest nodule at T6–T7. Malignant cells were detected in cerebrospinal fluid. She underwent laminectomy with excisional biopsy, and pathology showed medulloblastoma WHO grade IV. She was treated with chemotherapy and craniospinal irradiation and made a good recovery.

A 35-year-old female presented with episodes of frequent dizziness, ear fullness, and right ear tinnitus for 12 months. Head imaging revealed a right glomus tympanicum tumor. She underwent pre-operative endovascular embolization of the glomus tympanicum tumor with surgical, cyanoacrylate-based glue. Immediately after the procedure, she developed drowsiness and severe pain in the right temporal region. Further investigations revealed a right cerebellar stroke in the posterior inferior cerebellar artery territory. She was treated with intravenous heparin, followed by one year of oral anticoagulation. With rehabilitation, she significantly recovered from her post embolization stroke. However, the tumor was resected at another institution. Ten years later, follow-up imaging indicated a gradual increase in the size of the glomus jugulare tumor compressing the nearby critical vascular structures. She subsequently received radiation therapy to treat the residual tumor. Currently, she has no neurological deficit, but her mild dizziness, right ear tinnitus, and hearing impairment persist.

We describe an unusual presentation of Neuromyelitis Optica (NMO). A young boy presented with two days history of acute onset flaccid paraplegia. Electrophysiological study showed only absence of F wave. Initial exam was suggestive of Gullian-Barre Syndrome (GBS). Nevertheless, MRI spine demonstrated a contrast enhancing lesion in conus medullaris. Few days later, patient developed bilateral optic neuritis. NMO was diagnosed then. Antibody to Aquaporin 4 was not found in the serum, but to Myelin Oligodendrocyte Glycoprotein (MOG) was present. Patient was refractory to IV IgG therapy. He continued to develop symptomatic new lesions in brain and spine. Later Rituximab therapy initiation ceased the disease. However, absent "F wave" in Nerve Conduction is quite a perplexing association. It may reflect concurrent peripheral nerve involvement which needs to be explored. This case is unique due to its atypical presentation and also to the best of our knowledge this is the first reported case of MOG positive NMO from Saudi Arabia.

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Background and Purpose:The COVID-19 pandemic has affected stroke care delivery. New triage systems have affected the code stroke process and lead to longer treatment times. We aimed to describe the clinical features of stroke during the pandemic and its' effect on the code stroke process.Methods: A descriptive, non-experimental, cross-sectional study was conducted in all stroke codes between March 1, 2020, and June 30, 2020. Demographic data, vascular risk factors, clinical symptoms (both neurological and respiratory), clinical exam finding, COVID-19 screening score, final clinical diagnosis, and use of thrombolytics and COVID-19 PCR results were collected. Chi-square, Fisher's exact test, Student's t-test, and the Mann-Whitney U test were used to compare the demographics and clinical characteristics between COVID-19 positive and negative patients.Results: Of 202 code strokes, 14% were COVID-19 positive. Fortyfive percent of stroke codes were diagnosed with stroke or transient ischemic attack. COVID-19 patients were on average 5 years younger. Stroke code rates dropped in March 2020 compared to 2019, then increased gradually. COVID-19 positive patients were more likely to present with symptoms and signs suggestive of large vessel disease. Respiratory symptoms (fever, cough, and shortness of breath) were more likely to be seen in COVID-19 positive patients. The COVID-19 triage checklist score was higher in the COVID-19 positive patients (5.7 vs 3.7). A checklist score of 4 or less was seen in 32% of COVID-19 positive patients compared to 52% of COVID-19 negative patients. Fourteen percent of stroke or transient ischemic attack (TIA) vs no stroke or TIA were COVID-19 positive. A deviation of trend in stroke code activation for non-citizens was observed.