Pembrolizumab, an immune checkpoint inhibitor targeting the programmed cell death 1 (PD-1) protein, is widely used for renal cell carcinoma but rarely causes central nervous system adverse events such as myelitis. A 58-year-old woman with stage IV renal clear cell carcinoma developed radiating hip pain, paresthesia, hypoesthesia (T10 and below), constipation, urinary retention, and sudden right-eye blurred vision one month after her sixth cycle of pembrolizumab and lenvatinib. Neurologic examination revealed asymmetrical inferior paraparesis, upper motor neuron signs, and right eye papilledema. MRI demonstrated patchy hyperintensity on C2-C6 and T2-T5, supportive of myelitis. Intravenous methylprednisolone was initiated, leading to pain relief and motor improvement. This is the first reported case of pembrolizumab-induced myelitis in Indonesia, emphasizing the importance of early recognition and corticosteroid therapy for optimal recovery.

Background: Electrical injuries are underreported in literature, but they can affect the peripheral and central nervous system causing permanent disability. Aims and objectives: This case report aims to highlight cervical spinal cord injury secondary to electrocution, a rare cause of spinal cord injury. Case report: We report the case of a 54-year-old housewife who presented with transient loss of consciousness and right sided hemiparesis following electrocution, while at home. Results: The patient met clinical critera for partial Brown- Sequard syndrome, which to our knowledge, has not been previously reported. She showed significant improvement over a month and is currently under monitoring. Conclusions: Electrical injury is a rare cause of normal MRI myelopathy and the potential for immediate, delayed, and long- term neurological disability.

We reviewed the influence of coronavirus disease 2019 (COVID-19) on the central nervous system reported in the literature since its prevalence. Common neurological symptoms of COVID-19 include altered or impaired consciousness, headache, dizziness, cerebrovascular accidents, and seizures, etc. Encephalopathy caused by or related to COVID-19 includes stroke, acute encephalitis, and Guillain-Barre syndrome. Concomitant COVID-19 in patients with vascular risk factors increased the risk of stroke; the hypercoagulable state and vascular dysfunction caused by COVID-19 also led to stroke. Acute encephalitis was usually accompanied by a history of headache, fever, and altered mental status, and shown hemorrhagic lesions or high signal on MRI. In Guillain-Barre syndrome, there was a time lag between infection with the primary pathogen and the onset of neurological symptoms, which generally manifest as limb paralysis and various sensory abnormalities. The review illustrated that COVID-19 lead to serious consequences of brain and brought difficulties to the treatment. Exploring the neural mechanisms of COVID-19 to better understand the activity of the virus in the brain and to prevent further viral damage to the brain is an urgent issue.