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remained medically stable and was discharged to an acute inpatient
rehabilitation facility.
Setting:
Academic Hospital Setting.
Results:
Upon admission to the rehabilitation facility, it was noted
that the patient had severe visual deficits as he was neither able to
identify objects and colors consistently when asked directly. He also
experienced visual hallucinations of flies and mentioned other objects
that were not present. Evaluation by an optometrist revealed an
acuity of 20/960 on both eyes and vitreal hemorrhages with difficulty
in visualizing the retina, optic nerve, or retinal vasculature, leading to
a diagnosis of Terson’s Syndrome. His visual hallucinations stemmed
from a condition called Charles-Bonnet Syndrome (CBS). The patient
was then referred to a retinal specialist and has been scheduled for
surgery.
Discussion:
After review of the literature, there has only been one
other reported case of a patient with CBS and Terson’s syndrome. His
visual deficits were not recognized during his acute hospital stay due
to his cognitive deficits. Treatment in this case would include vitrec-
tomy which would improve his vision and eventually improve his CBS.
Conclusions:
In patients who experience visual hallucinations after
complications of intracranial hemorrhage from a ruptured aneurysm, it
is important to discern acute blindness from a cognitive deficit. By
treating the underlying problem of a vitreal hemorrhage, this will not
only improve vision, but also improve cognition and speed
rehabilitation.
Level of Evidence:
Level V
Poster 357:
A Rare Case of Prolonged Todd’s Paralysis and his
Progression in Acute Inpatient Rehabilitation
Omar Osman (Willowbrook, IL, USA)
Disclosures:
Omar Osman: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 56-year-old man with a PMHx of hy-
pertension and polysubstance abuse (cocaine, heroin, marijuana,
and tobacco) presented to acute inpatient rehabilitation (AIR) for
right hemiparesis, hemianesthesia, and global aphasia. He was
found unresponsive on the floor and brought to the ED after he was
given narcan in the field for heroin overdose. While in the ED, the
health care team noted that his right arm was not moving and that
he was aphasic. He was admitted for CVA protocol. NIHSS
¼
7. He
had two CT head scans that were negative. Later the patient un-
derwent an MRI that was also unremarkable. EEG revealed an
abnormal study in both the awake and sleep states with spike and
wave discharges over the left temporal and occipital regions
consistent with focal dysfunction. The neurology and physiatry
teams determined that he had Todd’s Paralysis and that he was a
good candidate for AIR due to his profound impairments that did not
resolve after 72 hours.
Setting:
AIR.
Results:
This patient presented to AIR with profound expressive
>
comprehensive aphasia and FIM scores nearly all at 3 (moderate
assistance). After 2 weeks of AIR the patient was discharged with FIM
scores of 7 and his aphasia improved to be a simple anomic aphasia.
Discussion:
This is a rare case of Todd’s Paralysis in which the pa-
tient’s symptoms continued for 2 weeks (usually resolve within 48hrs).
He had consistent small gains while in AIR until returning to nearly his
baseline level. After a thorough literature search there were no cases
found discussing Todd’s Paralysis and AIR or Todd’s Paralysis lasting
greater than 96 hours.
Conclusions:
Although Todd’s Paralysis usually resolves within 48 hrs,
there are isolated cases where it may take longer. In these cases AIR
may be beneficial to help improve function in impairments such as
aphasia and weakness.
Level of Evidence:
Level V
Poster 358:
Effective Proprioceptive Exercises for Sensory Ataxia
due to Thalamic Stroke: A Case Report
Baruch Kim Resident (NYIT COM, New York, New York, United States),
Yu M. Chiu, DO, Xuemei Qu, MD
Disclosures:
Baruch Kim: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
We present a case of a 60-year-old man
with sensory ataxia and hemiparesis following a subacute hemorrhagic
thalamic stroke. During acute inpatient rehabilitation, it was deter-
mined that his left-sided ataxia was due to infarct in the right lateral
thalamus. Left hemiparesis was likely caused by the infarct in the
posterior limb of the right internal capsule. This represents a rare
documented case of sensory ataxia with hemiparesis following
thalamic and internal capsule infarct.
Setting:
Acute Inpatient Rehabilitation.
Results:
A 60-year-old man with PMH of HTN and cocaine use who
presented with 2 months duration of left lower extremity edema.
On examination, he demonstrated left hemiparesis with no sensory
deficits. Heel-to-shin, finger-to-nose, and pronator drift showed
intention tremor and left sided dysmetria. The Romberg test was
positive. CT head revealed a subacute infarct involving the right
posterior limb of the internal capsule and the right lateral thal-
amus. MRI later revealed a subacute hemorrhagic stroke within the
posterolateral portion of right thalamus. During the acute rehabil-
itation course, he received intensive gait training in a somatosen-
sory-motor approach with single-multiple joint position matching/
tracking/reaching tasks with visual cueing. He became able to
ambulate with assistance from wheelchair-dependent level (Berg
scale from 9 to 28/56).
Discussion:
To our knowledge, one-sided sensory ataxia caused by the
contralateral thalamic infarct is rare. The ventral posterolateral nu-
cleus of thalamus receives inputs from medial lemniscus of the pos-
terior column-medial
lemniscus pathway which conveys
proprioception from joints. It is important to distinguish between
cerebellar ataxia and thalamic ataxia when personalizing an effective
rehabilitation plan.
Conclusions:
There are scanty reports in rehabilitation field regarding
ataxia caused by thalamic stroke even though there has been abun-
dant information for management of ataxia due to cerebellar damage.
These two types of ataxia are fundamentally different in terms of
mechanism and therefore the rehabilitative management should be
different.
Level of Evidence:
Level V
Poster 359:
Iatrogenic Femoral Nerve Injury in a Patient with
Preexisting Peroneal Neuropathy: A Case Report
Katie Hatt, DO (Temple Univ Hosp, Philadelphia, PA, United States),
Ernesto Cruz, MD, Dayna M. Yorks IV, OMS, Ryan A. Menard, DO
Disclosures:
Katie Hatt: I Have No Relevant Financial Relationships To
Disclose
Case/Program Description:
A 59-year-old man with history of trau-
matic left common peroneal nerve injury complained of worsening left
leg paresthesia and weakness status post right hemi-colectomy for
bowel obstruction.
Setting:
Acute care hospital.
Results:
Manual muscle testing of left lower limb strength
revealed 4/5 hip and knee flexion, 1/5 knee extension, 0/5 ankle
dorsiflexion and eversion, 5/5 ankle plantar flexion and inversion.
Sensation was decreased over anterior thigh, medial and lateral
leg. Magnetic resonance imaging ruled out L3 radiculopathy.
Computed tomography of the pelvis showed no evidence of he-
matoma. The patient was no longer able to compensate for foot
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Abstracts / PM R 9 (2017) S131-S290