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weakness. Of note patient had recently returned from a trip to the
Dominican Republic 2 weeks prior. Patient reported significant amount
of mosquito bites sustained while abroad. Upon return, the patient
noted fevers, rash, joint pain and flu-like symptoms which then pro-
gressed to numbness and lower extremity weakness. EMG/NCS showed
diffuse demyelination, sparing of the sural nerves and involvement of
the median nerves supporting the diagnosis of GBS. Zika infection was
confirmed with PCR and lumbar puncture which showed albu-
minocytologic dissociation. During acute hospitalization, the patient
was noted to have worsening dysphagia, dyspnea and respiratory fa-
tigue and was admitted to the MICU service for respiratory monitoring
and eventual intubation. Gradual improvement of respiratory function
was noted after treatment with IVIg and patient began a bedside
rehabilitation program until admission to acute inpatient
rehabilitation.
Setting:
Acute Rehabilitation Hospital, outpatient ambulatory clinic.
Results:
Initially, the patient was noted to be max to total assist for
ambulation, transfers and portions of self-care. A comprehensive
rehabilitation plan was implemented to address her functional im-
pairments. on discharge to home the patient was noted to be modified
independent to with transfers and self-care. She continued with
outpatient therapy and has progressed to full functional
independence.
Discussion:
A recent editorial was published by the New England
Journal of Medicine which showcased an association of GBS with Zika
infection. To our knowledge, this is the first case of successful ongoing
rehabilitation management of Zika virus associated GBS.
Conclusions:
With further study the Zika virus and advocation for
rehabilitation management, this may assist with improving functional
outcomes for patients presenting with Guillain Barre syndrome asso-
ciated with Zika infection.
Level of Evidence:
Level V
Poster 331:
Multiple Drug Induced Parkinsonism Secondary to
Chronic Risperidone Use and Lithium in an Adult with
Bipolar Disorder
Jenny A. Yin, DO (Schwab Rehab Hospital, Chicago, IL, United States),
Wyatt Kupperman, DO, Steven Kreis, DO
Disclosures:
Jenny A. Yin, DO: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
This is a 59-year-old man with a past
medical history of hypertension, bipolar disorder, chronic systolic
heart failure, and chronic obstructive pulmonary disease presenting to
the acute care hospital with frequent falls, bradykinesia, and urinary
incontinence. Of note, he was previously seen by a movement disorder
clinic for bradykinesia and gait instability. At that time he was taken
off of his risperidone; he was switched to valproic acid and lithium,
with subsequent improvement. On examination, the patient displayed
masked facies, cogwheeling, bradykinesia, but no tremor. CT head
revealed chronic microangiopathic changes. His symptom etiology was
thought to be due to previous chronic risperidone use. Urinary incon-
tinence was thought to be from being unable to reach the bathroom in
time due to bradykinesia. He was transferred to the acute inpatient
rehabilitation hospital setting. At this time his lithium level was
checked, and adjusted to a lower dose due to a supratherapeutic
level.
Setting:
Tertiary Care Hospital/Acute Inpatient Rehabilitation
Hospital.
Results:
The patient completed a course of inpatient rehabilitation
and was discharged home to his family at a modified independent level
for his ADLs, mobility, transfers, and self-care. He had significant
improvement in movement initiation and bradykinesia after his lithium
dose was lowered.
Discussion:
This is a rare case of multiple drug induced parkinsonism
caused by an atypical neuroleptic and lithium, in two separate events.
Movement disorders can be caused any anti-dopaminergic medication,
and less commonly, by atypical neuroleptics, such as risperidone.
Rarely, lithium has been documented to cause a tremor similarly seen
in Parkinson’s Disease.
Conclusions:
This is a rare case of multiple drug induced parkinsonism
in an adult individual. Clinicians should be wary of the signs and
symptoms of parkinsonism resulting from adverse medication effects.
Level of Evidence:
Level V
Poster 332:
Cervical Spinal Cord Stimulator Insertion Causing
New Onset Tetraplegia Compromising
Communication in a Hearing Impaired Family: A Case
Report
Jason B. Edwards (The University of Texas Health Science Center At
Houston), Mark D. Fredrickson, MD
Disclosures:
Jason Edwards: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A hearing 72-year-old woman married to
her hearing-impaired husband of 44 years underwent cervical spinal
cord stimulator placement for failed back syndrome. Patient had a C4-
C5 corpectomy and C3-C6 fusion with instrumentation approximately 2
years prior for cervical myelopathy. She had residual bilateral upper
extremity pain for which she had a cervical spinal cord stimulator trial
with good results before undergoing permanent placement of a spinal
cord stimulator. Patient had acute onset tetraplegia following the
procedure. The stimulator was removed 1 week after placement with
no improvement in symptoms. Patient was then admitted to inpatient
rehabilitation. She showed minimal improvement in her fine motor
skills over the course of 1 week. MRI showed a spinal cord contusion
and posterior cavitation at the site of the stimulator insertion. She was
evaluated by neurosurgery and underwent a C4-T1 laminectomy with
concern for potential worsening cord compression. Patient was then
readmitted to inpatient rehabilitation.
Setting:
Acute Inpatient Rehabilitation.
Results:
At 3 weeks post stimulator removal, patient showed minimal
improvement in fine motor skills. She had worsening anxiety and
insomnia secondary to impaired communication with her hearing-
impaired husband.
Discussion:
This case is significant in that tetraplegia following spinal
cord stimulator insertion is a rare event in itself. Furthermore, given
this patient’s unique life circumstances, having a hearing-impaired
husband as well as a hearing-impaired son and daughter-in-law, her
loss of fine motor skills goes beyond functionality with activities of
daily living, also impairing her ability to communicate with her im-
mediate family.
Conclusions:
Spinal cord injury following spinal cord stimulator
placement is a rare event. However, this case exhibits the need for
careful patient selection as well as the importance of risk-benefit
analysis of each patient regarding potential complications of spinal
cord stimulator placement.
Level of Evidence:
Level V
Poster 333:
Improved Arousal with Frequent Zolpidem Dosing
after Traumatic Brain Injury: A Case Report
Ross D. Coolidge, DO (Rehabilitation Institute of Chicago, Chicago, IL,
United States), Mithra B. Maneyapanda, MD, David L. Ripley, MD, MS,
FAAPMR
Disclosures:
Ross Coolidge: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 22-year-old man with traumatic brain
injury was admitted for acute inpatient rehabilitation 1 month after
injury. MRI was notable for Grade 3 diffuse axonal injury with lesions in
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Abstracts / PM R 9 (2017) S131-S290