Coronavirus disease 2019 (COVID-19), a multisystemic disorder caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been associated with both venous and arterial thromboses. The hypercoagulable state of the disease poses a challenge to the patient’s management. We herein report a case of acute ischaemic stroke in a COVID-19 patient who had been treated with three days of Baricitinib, an immunotherapy that can potentially augment the thrombotic risks. The case highlights the dilemma faced when initiating immunotherapy in a COVID-19 patient and emphasises the importance of evaluating the patient’s thrombotic risks, balanced against the benefit of immunotherapy, to facilitate the selection of ideal candidates for the immunotherapy.

Orthostatic tremor (OT) is one of the rare abnormal movement conditions characterized by leg tremors of 13-18 Hz upon standing and is often diminished upon walking or sitting. The exact pathophysiology of OT is still not fully understood, and it is uncertain whether the tremor causes unsteadiness on standing or vice versa. Treatment is a tremendous challenge. Medication toxicity with ineffective medications may likely cause distress to the patients and the physicians. Gabapentin, clonazepam, levodopa, and pregabalin are among the medications that have been used. We herein report on an elderly patient with OT, distressed, and anxious who improved significantly with physiotherapy as an adjunct therapy to the conventional medications.

Multiple Sclerosis is an inflammatory demyelinating disease that affects the central nervous system, and is uncommon among the Asian population. It can present with a variety of symptoms, depending on the location of the demyelinating plaques, which could also potentially mimic a range of neurological and non-neurological disorders. We report a 24-year-old woman who presented with recurrent non-specific lower limb numbness, without any other neurological symptoms or signs. The symptoms were presumed to be nonspecific, but they re-occurred eight months later, leading to a more extensive investigation, including whole spine and brain MRI. The MRI showed multiple white matter lesions that are hyperintense on T2W/FLAIR, seen at the right corona radiata, bilateral parietal lobes, right periventricular region and spinal cord, with a simultaneous presence of gadolinium-enhancing and nonenhancing lesions, fulfilling 2017 Mc Donald’s diagnostic criteria for multiple sclerosis. After the careful exclusion of differential diagnoses, she was given pulsed IV methylprednisolone for 5 days, followed by oral teriflunomide. She improved partially, and at 2 months following discharge, she was tolerating the medication well with no further relapses.