S259 S290
Poster 399:
Acute Onset of Guillain-Barre Syndrome Secondary to
Churgh-Strauss Syndrome: A Case Report
Anthony Doss (Union, NJ, USA), Selorm Takyi, MD, Christine Greiss,
DO, Derrick Eng, DO
Disclosures:
Anthony Doss: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
The patient is a 57-year-old Caucasian
man who presented to a community hospital with sudden onset of
weakness in all extremities with pronounced right wrist and foot drop.
Of note, the patient also had a history of long-standing, oral steroid
dependent asthma. While admitted, a lung CT scan revealed a right
lower lobe speculated mass with an adjacent 8 mm nodule. CT scan of
abdomen and pelvis were unremarkable. CT guided lung biopsy
revealed an inflammatory infiltrate with no evidence of malignancy.
Lab work was remarkable for eosinophilia, positive P-ANCA and anti-
myeloperoxidase antibody. Thus, a diagnosis of Churgh-Strauss Syn-
drome was made, and the patient was started on methylprednisolone
and cyclophosphamide therapy. He subsequently developed a rash of
the bilateral lower extremities suspicious for vasculitis for which he
underwent biopsy that was remarkable for demyelination. He was also
noted to have significant improvement of his weakness after multiple
intravenous immunoglobulin treatments. The patient was subse-
quently transferred to an acute inpatient rehabilitation unit where he
showed persistent improvement of his muscle weakness.
Setting:
Community Hospital.
Results:
The patient’s muscle weakness improved with acute reha-
bilitation following intravenous immunoglobulin administration.
Discussion:
This is the first reported case, to our knowledge, of
Guillain-Barre Syndrome secondary to Churgh-Strauss Syndrome.
Conclusions:
Acute onset of Guillain-Barre Syndrome is possible
following any inflammatory state including Churgh-Strauss Syndrome.
Level of Evidence:
Level I
Poster 400:
Popliteus Rupture in Spinal Cord Injury Patient Presenting
as Knee Effusion: A Case Report
Eric S. Larsen (Thomas Jefferson University Hospital), Mendel Kupfer,
MD
Disclosures:
Eric Larsen: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 67-year-old man presents post aneu-
rysm repair with post-operative paraplegia (T4 ASIA-C). Acute care
complications included vocal cord paralysis and a small right Soleal
thrombus for which an IVC filter was placed. He was admitted to an
acute inpatient rehabilitation facility and 18 days into his stay, a new
right knee effusion was noted on physical examination. X-rays were
completed and showed cortical irregularity along the lateral margin of
the tibial plateau raising concern for a segond fracture. Repeat right
lower extremity ultrasound did not reveal a deep vein thrombosis. An
MRI verified an acute popliteus disruption along with non-acute
bilateral meniscus tears.
Setting:
Acute Inpatient Rehabilitation Hospital.
Results:
The patient developed an acute right knee effusion 18 days
into his stay and while confounding factors such as a recent right soleal
vein thrombus and bilateral meniscus tears may also cause edema that
mimics these findings, an ultrasound no longer demonstrated the
thrombus and the only acute findings included the lateral tibial avul-
sion with popliteus disruption. The popliteus internally rotates the
tibia or externally rotate the femur based on position is utilized in
knee flexion. This injury usually does not occur in isolation, but clinical
exam and radiologic evidence support the diagnosis.
Discussion:
Knee effusions are a common entity seen across many
medical specialties. Although spinal cord injury patients may develop
these from most conditions that affect the general population, their
unique condition may introduce risk to develop them. The injuries that
cause knee effusions and their translation into spinal cord injury care
should be reviewed and promote a discussion on injury prevention
strategies.
Conclusions:
Our patient developed a knee effusion with evidence
suggesting an acute injury of the popliteus muscle to be the inciting
cause. The differential diagnoses were evaluated and potential
mechanisms discussed to validate the diagnosis.
Level of Evidence:
Level V
Poster 401:
An Incidental Finding of an Idiopathic Isolated Median
Motor Neuropathy in an Asymptomatic Veteran: A
Case Report
Lisanne C. Cruz, MD (Mt Sinai Hlth Sys, Brooklyn, New York, United
States), Svetlana Ilizarov, MD
Disclosures:
Lisanne Cruz: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 34-year-old right handed man status-
post bilateral ulnar nerve transposition was referred for an electro-
diagnostic study to evaluate ulnar nerves for long-term surgical
outcome. Test demonstrated normal findings for bilateral ulnar
nerves, however, an atypical isolated median motor neuropathy was
identified in this young asymptomatic patient. Surgical treatment was
avoided with close monitoring that showed continuous nerve recovery
over a year period.
Setting:
Academic Physiatry Clinic.
Results:
The patient was a young, healthy military veteran. He denied
hand paresthesias or weakness and the physical exam was negative for
thenar atrophy. Phalen’s and tinnel’s were negative. The electro-
diagnostic studies identified a rare median motor neuropathy with
both axonal and demyelinating features suggestive of an isolated
involvement of the motor branch of the median nerve. Left median
motor nerve showed a significantly prolonged distal latency of 7.2 ms
stimulating above and below the transcarpal ligament with reduced
amplitude of 3.7 m. There was no evidence of denervation on needle
exam of abductor policis brevis. Median sensory evaluation was normal
as was the combined sensory index. Subsequent nerve conduction
studies 3 months, and a year later showed gradual improvement in
distal latency (5.9 ms) and normal amplitude of 7.8 Mv suggestive of a
neuropraxic process below the transcarpal ligament.
Discussion:
The severity of carpal tunnel syndrome (CTS) is frequently
assessed by a degree of motor nerve distal latency prolongation. In
rare cases, absence of sensory involvement could be found and
attributed to other etiologies (ganglion, fascia compression, etc) or
anatomical variant rather than CTS.
Conclusions:
Rehabilitation physicians are uniquely equipped to di-
agnose and interpret rare neuropathies given their aptitude in elec-
trodiagnostic studies. Their knowledge of clinical presentation and
anatomical variants could guide other clinical decision making and
often avoid unnecessary surgery.
Level of Evidence:
Level V
Poster 402:
Cerebral Amyloid Angiopathy in the Acute Rehabilitation Unit:
A Case Series
Atira H. Kaplan, MD (Albert Einstein Col of Med, Bronx, NY, United
States), Maria A. Jouvin-Castro, MD, Gary N. Inwald, DO
Disclosures:
Atira Kaplan: I Have No Relevant Financial Relationships
To Disclose
S259
Abstracts / PM R 9 (2017) S131-S290