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Neurological manifestations, such as encephalopathy, intracranial neuropathy, headache, and cognitive decline, are often presented in patients with COVID-19 infection. Since the onset of the pandemic, acute ischemic stroke associated with a hypercoagulable state caused by COVID-19 is increasingly being reported. Hemorrhagic stroke is also reported via poorly understood mechanisms. We report one of the first-ever cases of intraparenchymal hemorrhage, subarachnoid hemorrhage secondary to reversible cerebral vasoconstriction syndrome in a patient with COVID-19 infection.

Moyamoya syndrome is a chronic and progressive narrowing of the arteries in the brain caused by different mechanisms than the genetic mutation that leads to moyamoya disease. It is characterized by the narrowing and/or closing of the carotid artery with a collateral circulation development around the blocked vessels to compensate for the ischemia. In this report, we present a unique case of moyamoya syndrome that developed over the course of a few months in a patient with new-onset strokes and seizures in the setting of late diagnosis of neurosyphilis and acquired immunodeficiency syndrome (AIDS). To our knowledge, moyamoya syndrome secondary to coinfection with AIDS and meningovascular neurosyphilis has only been reported once in the literature.

A retro odontoid pseudo tumor is a mass lesion lying posterior to the odontoid process along the dura. It is a disease process seen in inflammatory and non-inflammatory conditions causing chronic atlanto-axial instability. This type of mass has the potential to enlarge causing cervicomedullary compression and symptoms of myelopathy. In the past, authors have relied on a more invasive, direct approach to decompress the mass including an anterior trans oral odontoidectomy and a posterior trans-dural resection. The objective of this case report is to describe the use of an indirect approach, cervical fusion with decompressive laminectomy, to successfully treat a retro odontoid pseudo tumor in a geriatric patient. A male patient in his late 90’s presented with inability to ambulate, global paresis, and long tract signs in the upper extremities. He was found to have a large odontoid mass with compression at the cranio-cervical junction. He underwent cervical fusion with instrumented fixation from C1-6 and decompressive laminectomy from C4-6. Over a follow-up period of two years, there was improvement in the patient’s motor weakness and ambulation. Radiographic evaluation at the two-year mark showed marked reduction in pannus size. Indirect approaches to decompression in patients with retro odontoid pseudo tumor using techniques such as cervical fusion may be a safe for effective treatment in patients of advanced age, with multiple co-morbidities, and inability to tolerate lengthy surgical procedures.