S248 S290
Results:
Patient demonstrated functional improvements with inten-
sive therapies, and required less assistance in ambulation and activ-
ities of daily living. Environmental adjustments to therapies were
required, including working in smaller gym with fewer people and
distractions as patient expressed fear of falling during ambulation and
felt more secure with familiar therapists in smaller group settings.
Another barrier faced involved behavior as patient at times was un-
willing to give maximal effort in therapies and expressed desires to be
home. Limitations to other distractions such as phone usage were
required for complete participation in therapies; parents of patient
were supportive in this.
Discussion:
Patients with Down Syndrome are more susceptible to
immunologic diseases including autoimmune endocrinopathies, type 1
diabetes mellitus, and acute lymphoblastic leukemia. It has been
speculated this is due to genes on the trisomic chromosome 21. This is
the first documented case of polyneuropathy with a possible auto-
immune etiology.
Conclusions:
Down Syndrome may predispose patients to autoimmune
polyneuropathy. These patients benefit from modified inpatient
rehabilitation to account for intellectual disability and behavioral
challenges.
Level of Evidence:
Level V
Poster 366:
Acute Disseminated Encephalomyelitis Mimicking
Cocaine Induced Cerebral Ischemia
Wade O. Johnson, DO (NY Presby Hosp/Columbia/Cornell, New York,
NY, United States), Danielle Bousquet, PT, Emily Lyons, MS OTR/L,
Chichang David Lin, MD
Disclosures:
Wade Johnson: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
Acute disseminated encephalomyelitis
(ADEM) is a rare condition most commonly seen in children that is
often preceded by a viral or bacterial infection. Common presenting
symptoms include headache, fever, altered mental status, motor and
sensory deficits, and oculomotor deficits.
Setting:
Inpatient Rehabilitation Unit.
Results:
A 52-year-old man presented to acute care hospital with
complaints of dizziness, diplopia, and imbalance with multiple falls
for 1 week. During admission, symptoms progressed prompting MRI
revealing multifocal regions of patchy T2 hyperintensity consistent
ischemic foci prompting diagnosis of stroke in setting of cocaine use
and hypertension. Patient was admitted to acute rehabilitation with
functional level of total assist for all ADLs and ambulation, and
remained at those functional levels despite treatment with anti-
platelet and conventional stroke rehabilitative therapies. On day
29, patient developed acute flaccid paralysis of LUE. Repeat MRI
revealed progression of T2 hyperintensities throughout the brain, as
well as edge enhancing lesions consistent with active demyelin-
ation. Patient was managed with IV steroid, followed by oral steroid
taper with rapid improvement in clinical status. Workup also
revealed urinary tract infection which was successfully treated with
IV and oral antibiotics.
Discussion:
Patient’s presenting symptoms, and risk factors of prior
cocaine use and hypertension led to initial diagnosis of stroke during
acute hospitalization. Episode of acute left arm weakness is being
attributed to development of UTI which prompted further workup
allowing new diagnosis of ADEM. Upon receiving treatment for ADEM,
patient showed rapid improvement clinically, and eventually func-
tionally with targeted therapy.
Conclusions:
Multifocal hyper-intensities on neuroimaging, as seen in
cocaine induced vasculitis may appear ischemic, but share many
similarities to demyelinating disease. While rare, it is important to
consider a demyelinating process such as ADEM in young patients with
presumptive diagnosis of stroke displaying waxing and waning neuro-
logical signs and making minimal functional gains in acute
rehabilitation.
Level of Evidence:
Level V
Poster 367:
A Rare Case of Acute Disseminated Encephalomyelitis
(ADEM) in an Adult Patient with Cystic Fibrosis: A
Case Report
Simon M. Willis, MD (WA Hosp Cntr/Georgetown Univ, Washington,
District of Columbia, United States), Michele Anderson, BSc,
Camilo Castillo, MD
Disclosures:
Simon Willis: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 26-year-old man with a history of cystic
fibrosis who developed acute back pain with leg numbness and
weakness presented with an inability to stand or ambulate after res-
olution of fever and cough with antibiotic treatment.
Setting:
Inpatient academic center.
Results:
At an outside hospital a lumbar puncture was performed
showing cerebrospinal fluid with 1500 red blood cells, 1071 white
blood cells, glucose of 54, protein of 188, and negative cultures.
Magnetic resonance imaging (MRI) revealed symmetrical abnormal
central cord signal after which he was transferred to the university
hospital for management of presumed ADEM. Upon transfer he was
placed on decadron and broad-spectrum antibiotics. Seven treat-
ments of plasmapheresis were completed with minimal improve-
ment of lower extremity mobility, however repeat MRI
demonstrated an interval resolution of hyperintense cord signals
from his brain down to the T1 level. He was admitted to our
inpatient spinal cord injury unit with an L1 ASIA C equivalent level
of insult. Upon discharge from acute inpatient rehabilitation he
was walking more than 30 feet with a rolling walker with minimal
to moderate assistance.
Discussion:
ADEM is a rare demyelinating condition that predomi-
nantly affects the white matter of the brain and spinal cord. It is
usually immune mediated and generally provoked by an identifiable
febrile prodromal illness, commonly a viral infection. More than 80% of
cases occur in children less than 10 years of age with less than 3%
occurring in adulthood. Patients with cystic fibrosis have an increased
likelihood of contracting both viral and bacterial infections increasing
their risk of developing ADEM.
Conclusions:
Patients with cystic fibrosis with acute development of
polyfocal neurologic deficits require prompt neurologic assessment
and screening for acute demyelinating syndromes with a high suspicion
reserved for ADEM. Although most recover completely, patients should
be followed linearly as some may develop secondary pathological
residua.
Level of Evidence:
Level V
Poster 368:
Retroperitoneal Hematoma Causing Right Hip Pain
Status Post Recombinant Tissue Plasminogen
Activator (rt-PA) Administration for Acute Ischemic
Stroke: A Case Report
Simon M. Willis, MD (WA Hosp Cntr/Georgetown Univ, Washington,
District of Columbia, United States), Rachna Malhotra, DO
Disclosures:
Simon Willis: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 66-year-old woman who received re-
combinant tissue plasminogen activator (rt-PA) administration after a
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Abstracts / PM R 9 (2017) S131-S290