S240 S290
supporting the diagnosis. CT chest was ordered to evaluate for possible
granulomatous lesions for future biopsy.
Conclusions:
Definitive diagnosis of neurosarcoidosis requires confir-
mation by biopsy, however, exclusion of other causes of neuropathy
with EDx testing is also imperative. Early diagnosis is vital so the
appropriate management can be started in a timely manner. Clinicians
should be aware of this rare diagnosis in patients who present with
unusual symptoms with negative workups.
Level of Evidence:
Level V
Poster 340:
Pancreatic Dysfunction as a Sequela of Autonomic
Dysfunction in a Patient with Axonal Variant of
Guillain-Barre Syndrome: A Case Report
Peter D. Lee (New York Medical College (Metropolitan), White Plains,
NY, USA), Radomir Kosanovic, MD, Haresh Sampathkumar, MD,
Sumankumar Brahmbhatt, MD
Disclosures:
Peter Lee: I Have No Relevant Financial Relationships To
Disclose
Case/Program Description:
A 30-year-old man with no significant past
medical history admitted after severe ketoacidosis due to unknown
substance consumption. Patient was managed with mechanical
ventilation and he subsequently developed pneumonia and quad-
riparesis. Work up revealed diagnosis of Guillain-Barre syndrome. Pa-
tient received intravenous immunoglobulin. Electrodiagnostic study at
a later date showed axonal sensorimotor polyneuropathy. His hospital
course was also significant for cardiac arrests, respiratory and deglu-
tory muscle weakness requiring tracheostomy and percutaneous
endoscopic gastrostomy, severe autonomic dysfunction causing fluc-
tuations in blood glucose and blood pressure, tachycardia, diarrhea,
urinary retention, and decreased salivation.
Setting:
Acute Inpatient Rehabilitation.
Results:
After admission to acute inpatient rehabilitation gross blood
glucose fluctuations despite stable feeding and insulin regimen, was
most difficult to manage. Three months later his blood glucose levels
stabilized along with other sequela of autonomic dysfunction.
Discussion:
To our knowledge, report of pancreatic dysfunction has
not been reported in Guillain-Barre syndrome. The effect of auto-
nomic nervous system dysfunction on the pancreas can be dangerous
and life threatening. These patients would require very close moni-
toring of blood glucose. Prognosis of this condition is self-limiting.
Conclusions:
Clinicians should be alerted about the possibility of
pancreatic dysfunction as a sequela of autonomic dysfunction in pa-
tients with axonal variant of Guillain-Barre syndrome.
Level of Evidence:
Level V
Poster 341:
Lower Trunk Brachial Plexus Injury Following
Interscalene Block for Rotator Cuff Repair: A Case
Report
Diana L. Marchese
Disclosures:
Diana Marchese: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
MRI revealed full-thickness rotator cuff
tear. Pre-surgical examination showed 4/5 strength with painful arc
but no muscle atrophy, distal muscle weakness, or neurological
symptoms. Prior to surgery, she had an uncomplicated, ultrasound-
guided interscalene block with catheter placement. She underwent
successful arthroscopic-guided rotator cuff repair.
Setting:
Tertiary Care Hospital.
Results:
Following her surgery, she complained of left wrist pain in
the PACU. Orthopedics deemed her safe for discharge with the inter-
scalene catheter. Two days later the patient removed her catheter at
home per instructions without complication. Approximately 6 weeks
after surgery, she complained of residual numbness along the medial
aspect of her forearm and 4th and 5th digits, and decreased grip
strength with no flexion of the flexor digitorum profundus in her 4th
and 5th digits. An NCS/EMG study revealed left brachial plexopathy,
primarily affecting the lower trunk and ulnar nerve.
Discussion:
Brachial plexus injury is a rare but possible complication
following shoulder surgery with an interscalene block. Her injury could
have occurred during the block (less likely due to ultrasound guidance
and painless injection), during positioning (traction has been known to
cause brachial plexus injury, but this more commonly results in an
upper not lower trunk injury) or sometime between catheter place-
ment and removal (48 hours later).
Conclusions:
Brachial plexus injury, however rare, can occur with
interscalene block despite ultrasound guidance, standard intra-oper-
ative positioning, and self-removal of the interscalene catheter
Level of Evidence:
Level V
Poster 342:
New Onset Upper Extremity Weakness in a Woman
with Pre-Existing Paraplegia: A Case Report
Geoffrey Henderson, MD (University of Pittsburgh Medical Center,
Pittsburgh, PA, United States), Amanda L. Harrington, MD
Disclosures:
Geoffrey Henderson: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
Patient: A 42-year-old woman with T9
ASIA A paraplegia from a spinal cord injury that occurred in her mid-
twenties. Case Description: The patient, who has a history of
depression and past inpatient psychiatric admission, presented with
progressive left arm weakness. A few months prior, the patient had a
fall from a stair glide resulting in left upper extremity myofascial pain
but no motor changes. The patient underwent physical therapy and
was noted to have progressive left upper extremity weakness to the
point where she was unable to push her manual wheelchair. On pre-
sentation to the clinic, the patient’s left arm was non-functional and
plegic. The patient did not appear distressed or even fazed by the
weakness. She denied new trauma or systemic illness. Her acute on
chronic pain was controlled with gabapentin, oxycodone, and cyclo-
benzaprine. On exam, the right upper extremity was normal. Left
upper extremity strength was trace throughout with diminished light
touch sensation in all dermatomes. Reflexes were intact bilaterally.
Hoffman’s was negative. An EMG showed no evidence of neuropathic
changes. Blood work was unremarkable. Diagnostic MRI of the cervical
spine was negative for cervical pathology.
Setting:
Spinal cord injury clinic in a tertiary care hospital system.
Results:
The working diagnosis is conversion disorder and the patient
has been referred to psychiatry for further evaluation. She continues
to undergo physical therapy.
Discussion:
This is one of the first reported cases, to our knowledge,
of possible conversion disorder in a patient with long-standing para-
plegia from a spinal cord injury. Patients with conversion disorder
should be treated with therapy and supportive treatment. Psychiatric
evaluation may be beneficial.
Conclusions:
Conversion disorder should be considered in persons
with chronic disability and new onset weakness which is not explained
through diagnostic work-up.
Level of Evidence:
Level V
Poster 343:
Spinal Dural Arteriovenous Fistula-a Diagnostic Dilemma:
A Case Report
Alyssa Neph (University of Pittsburgh Medical Center, Pittsburgh, PA,
USA), John A. Horton, MD
Disclosures:
Alyssa Neph: I Have No Relevant Financial Relationships
To Disclose
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Abstracts / PM R 9 (2017) S131-S290