S258 S290
diagnosis of NMO-SD following Streptococcal pharyngitis w/presenta-
tion of myelitis of the brainstem without optic neuritis. Most cases of
NMO/ NMO-SD result in deficits that prevent patients from returning to
baseline and with relapses.
Conclusions:
We present an unusual initial presentation with a
promising rehabilitation course using unique modalities such as bionic
exoskeleton-assisted gait.
Level of Evidence:
Level V
Poster 396:
A Rare Case of Post-Stroke Psychosis: A Case Report
Vivek Sindhi, MD (Vidant Rehab Ctr/East Carolina Univ/Brod,
Greenville, NC, United States), James E. Eubanks, DC, MS (MS3)
Disclosures:
Vivek Sindhi: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 44-year-old man presented with seizure
activity at home, new-onset expressive aphasia and left hemiparesis.
Magnetic resonance imaging (MRI) of the brain revealed a right frontal
acute infarct in the anterior right middle cerebral artery distribution.
Patient was discharged home after appropriate medical therapy. He
presented 4 months later with auditory hallucinations since his stroke.
He endorsed voices telling him that he is worthless, better off dead,
and not the same person he used to be. He also admitted to visual
hallucinations, stating that he sees people in his presence without
making out who they are. His wife admitted that since the stroke he
has been out of character causing awkward social interaction and
becoming angry with strangers. His wife reports that he lost his temper
in public yelling that he will kill everyone.
Setting:
Inpatient Rehabilitation at Tertiary Care Hospital.
Results:
The patient was initially admitted to the inpatient psychi-
atric unit for psychosis secondary to organic neurologic infarction and
suicidal/homicidal ideations. The patient’s psychosis gradually
improved over the course of the hospitalization with risperidone and
divalproex therapy. He was subsequently admitted to inpatient reha-
bilitation. His suicidal/homicidal ideations resolved and his auditory
and visual hallucinations decreased in intensity to the point where he
was no longer distraught by them. He required frequent follow-up
outpatient for continued management of his post-stroke psychotic
disorder.
Discussion:
Neuropsychiatric disorders such as depression and anxiety
are common after stroke. However, post-stroke psychosis including
symptoms of auditory and visual hallucinations, homicidal/suicidal
ideations, and agitated behaviors are uncommon. Anterior frontal lobe
infarctions, such as in our patient, may be associated with psychotic
disorders.
Conclusions:
It is essential to be aware of this rare, but possible,
post-stroke complication so we as rehabilitation physicians may be
equipped to manage psychotic disorders.
Level of Evidence:
Level V
Poster 397:
Stroke Caused by Varicella-Zoster Vasculitis: A Case Report
Mayya Gorbal, MD (Albert Einstein Col of Med), Yonghoon Lee, MD,
Shayan Senthelal, MD, Maria A. Jouvin-Castro, MD
Disclosures:
Mayya Gorbal: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 64-year-old right-handed woman with
a past medical history of hypertension, diabetes mellitus and three
prior strokes with residual left hemiparesis presented with nausea,
slurred speech and worsening weakness in the left upper and lower
extremities. Physical examination was notable for dysarthria, left
facial droop, 2/5 motor strength in the left upper and lower ex-
tremities, dysmetria and significant assistance with bed mobility
and standing. MRI brain showed acute infarcts in the right pons and
left periatrial white matter. MRA brain showed multiple posterior
circulation infarcts, some of which were in atypical vascular loca-
tions and raised suspicion for vasculitis. A transthoracic echocar-
diogram was unremarkable. A lumbar puncture (LP) was done for
further workup of vasculitis. The cerebrospinal fluid (CSF) was sig-
nificant for one white blood cell and an elevated total protein
count, with polymerase chain reaction (PCR) for herpes simplex
virus (HSV) and varicella zoster virus (VZV) pending. The patient was
then discharged to acute inpatient rehabilitation for physical and
functional optimization.
Setting:
Acute Inpatient Rehabilitation Facility.
Results:
The patient had an overall successful rehabilitation course
and remained highly motivated to regain function. During her stay in
rehabilitation, the CSF PCR results came back and were positive for
anti-VZV IgG. The patient was treated with five days of prednisone and
a 3-week course of Acyclovir. She underwent a comprehensive inpa-
tient therapy regimen with persistent improvement in speech, motor
strength and balance. She was fitted for a custom ankle-foot orthosis
to accommodate for her left ankle dorsiflexion weakness and to assist
with ambulation.
Discussion:
VZV vasculitis is a known, although rare, cause of stroke.
We present a case of this relatively uncommon etiology of a common
condition in a patient with a history of recurrent strokes.
Conclusions:
Cerebral vasculitis should be considered in select stroke
patients as it can cause functional deficits in this patient population.
Level of Evidence:
Level V
Poster 398:
Blinded by the LIGHT (Lacunar Infarcts Giving Him Typhlosis):
A Case Report
Raman Sharma (Burke Rehabilitation Hospital, White Plains, NY, USA),
Mery Elashvili, MD DO
Disclosures:
Raman Sharma: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
The patient is a 74-year-old right-handed
man who presented to an acute rehabilitation facility for multidisci-
plinary rehabilitation after acute ischemic lacunar infarcts in corona
radiata and parietal cortex. He initially presented with right-sided
weakness and dysarthria. The patient is always aware when he is about
to lose vision in the right eye and this represents an aura which has
been reproducible.
Setting:
150-bed acute multidisciplinary rehabilitation facility.
Results:
A comprehensive medical and drug investigation revealed a
history of HTN, HLD, glaucoma resulting in constant left eye blindness,
PVD, dysarthria-clumsy hand syndrome (DCHS). Workup was negative
for right ophthalmic artery stenosis as well as negative for atrial
fibrillation. EEG showed no evidence of seizure. During the patient’s
hospital stay, it was noted that anxiety served as a recognizable trigger
for the patient’s aura preceding episodes of uniocular right-sided
blindness. Neurology recommendation was to use Propranolol to treat
posterior migraine with aura. Psychiatry recommended Citalopram
and Clonazepam for anxiety.
Discussion:
This patient’s case is unique in that it initially presented
like a typical stroke, but then revealed an intriguing characteristic of
intermittent uniocular typhlosis of the right eye preceded by an aura.
This aura was accompanied by anxiety and DCHS with posturing. This is
a complication which we should monitor our patients for so they are
treated in a timely manner.
Conclusions:
This case represents a very unusual presentation so a
comprehensive rehabilitation team approach was essential in diagnosis
and management. This particular entity should be studied further as
there is no current literature documenting such a complication. The
collaborative efforts of Physical Medicine & Rehabilitation, Neurology,
and Psychiatry resulted in appropriate care and treatment.
Level of Evidence:
Level V
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Abstracts / PM R 9 (2017) S131-S290