Letter to Editor Coronavirus disease 2019 (COVID-19) was first declared in December 2019 from Wuhan, China [1, 2]. It then has been reported a pandemic in March 2020 by the World Health Organization [3]. Clinical features of COVID-19 are different from asymptomatic to mild to moderate symptoms, such as fever, headache, myalgia, sore throat, anosmia, cough, fatigue headache, hemoptysis, and dyspnea to the life-threatening complications, including shock, pneumonia, acute respiratory distress syndrome, myocarditis, myocardial infarction, acute kidney injury, multi-organ failure, and even death [1, 2]. One of the possible routes for central nervous system (CNS) involvement by COVID-19 is diffusing through the respiratory tract to the olfactory bulb and the formation of blood clots in the CNS [1, 4]. COVID-19 has been associated with neurological complications, such as anosmia, stroke, paralysis, cranial nerve deficits, encephalopathy, delirium, transient ischemic attack, meningitis, acute stroke, encephalitis, and SEIZUREs...

Background: SEIZURE and syncope have similar clinical symptoms but different etiologies. Hence, DIFFERENTIAL DIAGNOSIS is crucial prior to intervention. This study evaluates the diagnostic importance of neuron specific enolase (NSE), creatine phosphokinase (CPK), and serum lactate dehydrogenase (LDH) for admitting patients with SEIZURE medical history to emergency department (ED) in order for DIFFERENTIAL DIAGNOSIS between syncope and SEIZURE. Methods: Patients with a short‑, lasting loss of consciousness admitted to the ED were recruited. All patients with a short‑, lasting loss of consciousness were eligible and EEG was conducted several times and was taken over a long period. Patients were then divided into two groups of SEIZURE and syncope. The biochemical markers levels of all the eligible patients were measured by a reputable laboratory. Results: In order to define specificity and sensitivity of different levels of biomarkers and the optimal cut‑, off points, ROC curves for each biomarker of syncope and SEIZURE patients admitted to ED were performed. AUC for NSE, CPK, and LDH were 0. 973 ±,0. 023, 0. 827 ±,0. 047, and 0. 836 ±,0. 043 respectively in 95% confidence level. Cut‑, off points for NSE, CPK, and LDH were determined 25. 12, 218. 09, and 193. 88 respectively. Conclusions: It was concluded that NSE, CPK and LDH levels were different significantly in SEIZURE patients compared to syncope ones. The SEIZURE group showed an increase in NSE, CPK and LDH level. Determining biomarkers level for DIFFERENTIAL DIAGNOSIS of SEIZURE and syncope can be applied as a supplementary test in addition to tests like EEG.

A 21-year-old man was referred to dermatology clinic for skin biopsy. He presented to neurology center with behavioral changes with cognition and memory disorders. He had two episodes of generalized tonic clonic SEIZURE and series of myoclonc jerks in his limbs and face especially after awakening since several months ago. In neurological examination, he had mini mental score as 13; with some degree of bradykinesia, limb rigidity and dysartheria. He had leaved school because of inability to learning. His sister had died 5 months ago from the same disease.We performed biopsy from his right axillary skin. Histopathological examination revealed multiple intracytoplasmic homogenous pale basophilic globi in apocrine glands acini which were showing PAS positive reactivity in special staining. Reminder of epidermis and mid reticular dermis was unremarkable.