S233 S290
Poster 318:
Assessment and Treatment of Foreign Accent Syndrome in
Stroke: A Case Report
Kristen E. Jost, MD (Marianjoy Rehab Hosp, Wheaton, IL, United
States), Sara Padalik, DO
Disclosures:
Kristen Jost: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 61-year-old woman presented to an
acute care hospital with right hemiparesis and was diagnosed with an
acute stroke. MRI revealed a left lentiform nucleus and lateral len-
ticulostriate branch ischemic infarcts. Seven days later she was
admitted to an acute rehabilitation facility. She was found to have
articulatory and prosodic speech deficits characteristic of a foreign
accent syndrome (FAS) resembling components of British, Polish, and
Irish accents. This case report demonstrates a successful therapeutic
approach to assessing and modifying the stress, rhythm, and intona-
tion elements of speech inconsistent with the patient’s native accent.
Setting:
Acute inpatient rehabilitation hospital.
Results:
The patient participated in speech therapy 5 to 6 days per
week in 30 to 60 minute sessions for 17 days. Initial assessment
included a baseline voice recording of the patient reading the
“Grandfather Passage”. Her goals included improving pronunciation
accuracy, intelligibility, and self-correction. Specific vowel and diph-
thong distortions were identified using the International Phonetic Al-
phabet (IPA). Based on the IPA phoneme distortions, the clinician
generated lists of 15 words for continued practice with use of audio
feedback. As she improved, word lists were expanded to patient-
generated sentences and conversation. Initial pronunciation accuracy
was 50% with 80% self-correction. On discharge day, she was re-
recorded reading the “Grandfather Passage”. Accuracy improved to
greater than 90% with 100% self-correction and overall improved
intelligibility.
Discussion:
Foreign accent syndrome is a rare presentation of stroke
with less than 100 cases reported worldwide. The deficits associated
with this syndrome can impair intelligibility, affecting the patient’s
quality of life. This study demonstrates an effective speech rehabili-
tation model of targeting and improving the stress, rhythm, and
intonation distortions associated with FAS.
Conclusions:
A structured rehabilitation model incorporating word-
lists that target phoneme distortions with audio feedback can improve
intelligibility, accuracy, and self-awareness in a stroke patient pre-
senting with FAS.
Level of Evidence:
Level V
Poster 319:
Levetiracetam Used as Monotherapy in Lance-Adams
Syndrome
Joel P. Castellanos, MD (Univ of Michigan), Sean R. Smith, MD,
Ryan Stork, MD
Disclosures:
Joel Castellanos: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 60-year-old man developed action-
induced hyperkinetic movements in the lower and upper extremities 4
weeks after suffering a cardiac arrest. The action-induced hyperki-
netic movements severely inhibited his ability to ambulate, transfer,
or participate in activities of daily living and he was transferred to
acute inpatient rehabilitation. After transfer, he was clinically diag-
nosed with Lance-Adams Syndrome (LAS), a form of post-hypoxic
myoclonus. The abnormal movements were severely inhibiting his
ability to effectively participate in therapy. The patient was initially
started on ropinirole, followed by risperidone, and finally
levetiracetam.
Setting:
Acute Inpatient Rehabilitation Facility.
Results:
Ropinirole caused minimal improvements in symptoms but
was discontinued secondary to nausea. Risperidone was dis-
continued secondary to worsening of his hyperkinetic movements.
The patient was started on levetiracetam 500 mg twice daily.
Within 2 hours of his initial dose of levetiracetam, there was dra-
matic decrease in the amplitude and severity of his action-induced
myoclonic movements. This improvement was sustained and he
experienced further improvements with an increase of the dose to
750 mg twice daily. He made rapid functional gains and was able to
be discharged home at a modified independent level with two
wheeled walker for ambulation, and independent for transfers and
activities of daily living.
Discussion:
LAS is an uncommon complication after cardiac or respi-
ratory arrest that occurs days to weeks after the hypoxic event. It is
characterized by muscle jerks initiated by voluntary movement. There
is no standard treatment or diagnostic criteria for this condition. There
have been positive results from various combinations of anti-epileptic
medications most commonly including valproate, clonazepam, and
levetiracetam.
Conclusions:
Lance-Adams syndrome can be a severely debilitating
complication that limits effectiveness of therapy after a hypoxic event
if not recognized and appropriately treated. Levetiracetam may be
used as an effective monotherapy with favorable side effect profile
compared to other treatment options.
Level of Evidence:
Level V
Poster 320:
The Head and the Heart - New Onset Multiple Sclerosis
Causing Broken Heart Syndrome: A Case Report
Hanzla Quraishi, MD (Marianjoy Rehab Hosp), Kim I. Lam
Disclosures:
Hanzla Quraishi: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 33-year-old woman with a past medical
history of Huntington’s disease presented with left upper and lower
extremity weakness for 3 days duration. At the time, the patient had
experienced falls at home secondary to weakness. CT Head on
admission was unremarkable. This was followed by MRI Brain which
revealed extensive white matter abnormalities consistent with multi-
ple sclerosis. On day 3 of admission, the patient acutely decom-
pensated. She complained of shortness of breath and chest
discomfort. Electrocardiogram demonstrated ventricular tachycardia
and a subsequent echocardiogram revealed a severely depressed
ejection fraction of 20%. Patient eventually improved clinically and
underwent a repeat echocardiogram on day 9 of admission which
revealed an improved ejection fraction of 40%. A subsequent auto-
mated implantable cardioverter-defibrillator was placed. Prior to
presenting, the patient had no cardiac history or predisposing risk
factors for heart failure.
Setting:
Acute Rehabilitation Hospital.
Results:
The patient completed a course of comprehensive inpatient
rehabilitation including physical, occupational, and speech therapies.
Discussion:
It has been postulated that there is a neurologic pre-
disposition to stress induced cardiomyopathy, specifically a link to
catecholamine release. This patient’s presentation corresponds to
less than 1% of cases. There is a higher preponderance in patients
with stroke or traumatic brain injury. In the rehabilitation setting,
patients should be monitored closely for signs and symptoms of
heart failure even with no predisposing risk factors or cardiac
history.
Conclusions:
Patients undergoing inpatient rehabilitation are at risk
for the development of new onset heart failure, even in the absence of
risk factors or previous cardiac history. Stress-induced cardiomyopathy
(colloquially known as broken heart syndrome) has been linked to
cerebrovascular accident, but rarely demonstrated a link to any other
S233
Abstracts / PM R 9 (2017) S131-S290