S226 S290
Poster 297:
Central Cord Syndrome in Third-Trimester Pregnancy:
A Case Report
Jennifer T. Yu (Temple University Hospital / MossRehab),
Marlyn Ramos Lamboy, MD
Disclosures:
Jennifer Yu: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 21-year-old woman at 33-weeks gesta-
tion with no significant past medical or obstetric history presented
with acute-onset burning back pain followed by persistent bilateral
upper extremity parasthesias and weakness. MRI was significant for
progressive ventrolateral cord signal abnormalities from C3-4 to T1
thought to be due to demyelinating process in the spinal cord versus
cord infarction. However, further workup was equivocal. She was
started on subcutaneous heparin for anticoagulation for the remainder
of her pregnancy. Fetal vital signs remained stable and no abnormal-
ities were noted in prenatal monitoring.
Setting:
Acute Rehabilitation Hospital.
Results:
The patient was admitted to our spinal cord injury service at
35-weeks gestation with the diagnosis of central cord syndrome of
unclear etiology. The patient had persistent bilateral upper extremity
weakness, particularly grasp weakness, which especially impacted
activities of daily living including dressing, grooming, child care, and
toileting. She had impaired sensation to light touch from dermatomes
C3-T11. She had no pulmonary abnormalities. She received intensive
inpatient physical and occupational therapy with a focus on grip and
grasp activities and on learning adaptive skills for infant care. Therapy
tasks included simulating diaper and clothing changes with a 4-pound
doll and managing baby bottles. She was closely monitored for
gestational hypertension and diabetes. Her obstetric care was coor-
dinated closely with her obstetric team for weekly prenatal checkups
and fetal ultrasounds. She was discharged at a supervision to setup
level for all mobility and activities of daily living.
Discussion:
This is the first reported case to our knowledge of non-
traumatic central cord syndrome in third-trimester pregnancy. Bilat-
eral upper extremity motor and sensory dysfunction is especially
challenging to an expecting mother who must anticipate future
childcare needs.
Conclusions:
Understanding the rehabilitation challenges and ob-
stetric needs of expecting mothers with central cord syndrome will aid
physiatrists in coordinating safe and effective plans of care.
Level of Evidence:
Level V
Poster 298:
Lewy Body Dementia in a Patient with Confounding
Post-Stroke Symptoms: A Case Report
Katie Hatt, DO (Temple University/MossRehab, Wilmore, PA, United
States), Nicholas C. Kinback, MD, Ning Cao, MD
Disclosures:
Katie Hatt, DO: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 77-year-old man who suffered a right
middle cerebral artery stroke 3 years prior presented to our rehabili-
tation center with 6-month history of progressive visual hallucinations
and behavioral symptoms characterized by increased agitation,
perseverative speech, and repetitive movements resulting in poorly
regulated sleep/wake cycle. The patient had been treated as post-
stroke psychosis with multiple neuroleptic agents. Overtime, his
behavioral symptoms deteriorated. Interestingly, he had a history of
cognitive decline and vivid dreams several years prior to stroke.
Setting:
Inpatient rehabilitation unit.
Results:
Neurological exam revealed left spastic hemiparesis and left
hemiparesthesias with tactile neglect. There was a resting tremor of
the right upper extremity and cog wheeling rigidity of the right wrist
and elbow. His speech was dysarthric, rapid and perseverative. He had
left facial droop with decreased facial expressions and predominance
of flat facies. Glabellar reflex was positive. Neuro-imaging showed a
chronic right middle cerebral artery infarct.
Discussion:
A diagnosis of dementia with Lewy bodies was made based
on the patient’s Parkinsonian symptoms, fluctuations in arousal and
cognitive dysfunction with intact memory. The diagnosis was further
supported by a history of visual hallucinations and sleep patterns
characteristic of rapid eye movement sleep behavior disorder. Treat-
ment goals focused on improving his sleep/wake cycle to decrease
burden of care. Anti-psychotic medications he had previously been
prescribed were tapered. Aricept and Ritalin were initiated. He
received interdisciplinary treatment including Physical, Occupational
and Speech therapy.
Conclusions:
A chronic stroke patient with fluctuating cognition and
visual hallucinations who did not respond to anti-psychotic treatment
was found to have probable Lewy body dementia. His functional status
improved after interdisciplinary rehabilitation treatment combined
with a cholinesterase inhibitor. Lewy body dementia is a common form
of dementia. Although treatment is limited, correct diagnosis is
imperative to avoid unnecessary pharmacologic interventions.
Level of Evidence:
Level V
Poster 299:
Neurosarcoidosis Presenting as a Spinal Cord Injury:
A Case Report
Ajaya T. Moturu, MD (Vidant Rehab Ctr/East Carolina Univ/Brod)
Disclosures:
Ajaya Moturu: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 39-year-old man initially presented
with a 2-week history of unsteady gait and neck pain. Patient was
found to have pain radiating to his shoulder along with numbness and
tingling in his hands and legs. Magnetic resonance imaging (MRI) cer-
vical spine and brain showed meningitis with hydrocephalus extending
to the upper cervical cord. Empiric antibiotics were started and lum-
bar puncture showed elevated cerebrospinal fluid (CSF) protein,
lymphocyte predominance, and normal glucose. Extensive infectious
work up was pursued and was negative. Serum and CSF angiotensin
converting enzyme (ACE) levels were obtained and were mildly
elevated in the CSF, normal in the serum. Patient had rapid neuro-
logical decline and was unable to ambulate or move upper extremities.
Repeat MRI showed worsening hydrocephalus and meningitis; patient
then had extra ventricular drain (EVD) placed. Following EVD place-
ment patient had some improvement in upper extremity strength with
no improvement in lower extremities.
Setting:
General Inpatient Rehabilitation Center.
Results:
Patient had EVD placed and gradually had improvement in his
upper extremity strength and movement however remained wheel-
chair bound due to no improvement in lower extremity strength. Pa-
tient had several episodes of worsening weakness during his admission.
With a slightly elevated CSF ACE level and normal serum ACE, with
otherwise negative workup, patient was thought to have
neurosarcoidosis.
Discussion:
Neurosarcoidosis typically presents with cranial nerve
involvement and seizures. Presentation with meningitis is less common
and involvement of the spinal cord is very rare. Patients with spinal
cord involvement in neurosarcoidosis can present similarly to spinal
cord injury and may benefit from spinal cord injury rehabilitation.
Conclusions:
It is very rare for patients to present with spinal cord
involvement and even more rare to be present without systemic
sarcoidosis. This is a diagnostic and treatment dilemma due to
inconsistent clinical manifestations and poor response to medical
treatment.
Level of Evidence:
Level V
S226
Abstracts / PM R 9 (2017) S131-S290