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especially notable on his left side, and his rehabilitation progress
declined. Neurology stated it was an effort-activated cerebellar
intention tremor caused by a stroke involving the restiform body and
adjacent accessory cuneate nucleus.
Setting:
Acute Rehabilitation.
Results:
The tremor improved with propranolol, dorsiflexion assist,
and neuromuscular reeducation. At discharge, he could ambulate 100
feet with rolling walker. Three months later, he reported 50%
improvement and was walking with a cane. At follow up with
neurology the tremor in his left leg was noted to be worse on weight
bearing, his propranolol dose was increased and he was continued on
therapy.
Discussion:
Four types of involuntary abnormal movements (IAMs)
have been described: chorea, dystonia, tremor, and parkinsonism.
The frequency of post-stroke tremor remains unclear, with sug-
gested incidence from 1% to 3.7%. Post-stroke IAMs can occur
immediately or be delayed and progressive. Data published on post-
stroke IAMs involves thalamic, lenticulate, and basal ganglia in-
farcts. Several studies show spontaneous resolution of abnormal
movements, while more complex IAMs require pharmacological
therapy or deep brain stimulation. Tremor therapy is limited to
benzodiazepines, valproic acid, primidone, and beta-blockers. Post-
stroke tremor is more commonly refractory to pharmacotherapy,
often requiring multiple medications. Adding weight to affected
limb has also been shown to dampen the tremor. Early identification
and treatment in this patient helped improve his ability to partic-
ipate in therapy.
Conclusions:
Tremor is a significant barrier to daily function espe-
cially in stroke patients who have other disabilities. Early identifica-
tion and treatment may help facilitate maximal recovery and
rehabilitation progress. Due to its rarity, there is limited information
about post-stroke tremor so further research is necessary.
Level of Evidence:
Level V
Poster 351:
Rehabilitation of a Patient with Statin-Associated
Autoimmmune Necrotizing Myositis: A Case Report
Annamaria L. Dunn, MD (JFK Med Cntr), Shaessa L. Wright, DO,
Alessandra Dunn, N/A
Disclosures:
Annamaria Dunn: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
The patient is a 79-year-old fully inde-
pendent man who was admitted to the hospital with weakness. He had
a 3-week history of weakness and dysphagia. He was evaluated as an
outpatient and was given the diagnosis of polymyositis after muscle
biopsy. His weakness increased until he was unable to ambulate and
transfer and was brought to the emergency room. At that time the
patient’s CPK level was greater than 10,000. He was on statins for
dyslipidemia so a HMG coA reductase antibody test was sent and was
positive. He was given the diagnosis of statin-associated autoimmune
necrotizing myositis. Patient required gastric tube placement.
Setting:
Acute Care 700 bed level one Trauma center/ Comprehensive
Stroke Center.
Results:
The patient was admitted from the acute hospital to an
inpatient acute rehabilitation unit. At the time of transfer the patient
was maximum assistance for balance, transfers and bed mobility. The
patient underwent a rigorous inpatient rehabilitation program and was
discharged home with his family moderate assistance for transfers and
ambulation.
Discussion:
Statin induced myositis has been well documented in the
literature. There is a spectrum of myositis and recently autoimmune
necrotizing myositis has been identified. The presence of HMG coA
reductase antibody is used in the diagnosis. Little is known about the
long-term prognosis and even less about the rehabilitation of such
patients. This form of myositis is rare and is thought to affect only 1 in
100,000.
Conclusions:
Acute inpatient rehabilitation can be beneficial to the
subset of patients diagnosed with the severe form of statin-associated
autoimmune necrotizing myositis.
Level of Evidence:
Level V
Poster 352:
Amantadine Used to Successfully Treat Agitation and
Cognitive Impairment 11 Months after Anoxic Brain
Injury: A Case Report
Nicholas F. Love, MD (Univ of Rochester, Rochester, NY, United
States), Lindsay C. Smith, NP, Sara Salim, MD, Nicole A. Strong, DO
Disclosures:
Nicholas Love: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
The patient suffered a cardiac arrest
during a cervical fusion, resulting in a brain injury. She participated
in inpatient rehabilitation and was discharged home with her parents
approximately 4 weeks later. At this time, she was independent for
mobility and ADLs, but needed 24 hour supervision for impulsivity and
memory impairment. While at home, she continued to have wors-
ening agitation with outbursts of anger and aggression. She presented
to her neurologist with severe agitation, paranoia and hallucinations
3 days after her chronic pain medications were abruptly dis-
continued. She was admitted for concern of acute opioid withdrawal
and Psychiatry was consulted for management of behavioral changes,
including hitting, biting, spitting and tearing clothing. For her
behavior, she was trialed on multiple anti-psychotics and mood sta-
bilizers without any improvement. Her function also worsened and
therapists could not safely work with her due to aggression. Reha-
bilitation was consulted 11 months after her brain injury and rec-
ommended starting amantadine 100 mg daily and within 2 weeks of
medication initiation she had greatly improved behavior and
function.
Setting:
Tertiary Care, Academic Hospital.
Results:
After 2 weeks of low dose amantadine, the patient no longer
required restraint vest and no longer displayed aggressive behavior.
She was able to begin working with physical and occupational therapy
and quickly progresses from a Max dependent to a supervision level.
Discussion:
Previous studies have shown that amantadine can improve
cognition and agitation in acute and chronic traumatic brain injury.
There is less data on patients with anoxic brain injury, especially for
chronic anoxic brain injury in a patient with worsening behavior.
Conclusions:
Amantadine is reasonable choice of medication to trial
for agitation and cognitive impairment in patients with anoxic brain
injury, even many months after injury.
Level of Evidence:
Level V
Poster 353:
Powered Exoskeleton Orthosis System Used in Gait
Training for a Patient with Guillain-Barre Syndrome:
A Case Report
Carlos Marrero Prats, MD (State University of New York (SUNY)
Upst, Syracuse, NY, United States), Kayla M. Roddick, MD,
Stephen R. Lebduska, MD
Disclosures:
Carlos Marrero Prats: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
The patient is a 71-year-old man who
contracted GBS after eating raw scallops infected with
C. jejuni
17
years ago. He received plasmapheresis with some improvement, but
had considerable residual weakness in the lower extremities. In the
ensuing years, his weakness necessitated use of bilateral lower ex-
tremity orthotics, and he developed some atypical increased lower
extremity tone. Multiple brain and spine MRI imaging as well as CSF
analysis and several electrodiagnostic studies confirmed his diagnosis
and failed to identify any additional pathology to explain his increased
S243
Abstracts / PM R 9 (2017) S131-S290