S187 S290
Discussion:
Use of immunosuppressant pharmacotherapy and IRF
services facilitated improved communication in the setting of primary
CNS angiitis. The interdisciplinary rehabilitation team was able to
identify the patient’s ability to use ASL as a modified communication
tool which became essential in providing adequate understanding of
the patient’s needs early in her rehabilitation course.
Conclusions:
Attaining a means of communication for patients while
they participate in rehabilitation is of utmost importance. For previous
users of ASL, this may be an option to consider.
Level of Evidence:
Level V
Poster 171:
Autoimmune Encephalitis in Setting of Stage IV Non-
Small Cell Lung Cancer: A Case Report
Grace L. Maloney, MD (Marianjoy Rehab Hosp, Naperville, IL, United
States), Dennis Keane, MD
Disclosures:
Grace Maloney: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 56-year-old woman with history of stage
IV non-small cell lung cancer (NSCLC) presented for rehabilitation
after an episode of acute right sided weakness and altered mental
status attributed to nivolumab associated autoimmune encephalitis.
Patient underwent right lung lobectomy and craniotomy with resection
of metastases after diagnosis of NSCLC 4 years ago. Surgery was fol-
lowed by chemotherapy and radiation. Chemotherapeutic regimen at
the time of presentation included nivolumab. CT and MRI imaging
demonstrated meningeal enhancement, but revealed no other find-
ings. Workup including CSF studies, UA, CBC, and CXR were remarkable
only for a urinary tract infection, however symptoms of confusion did
not resolve after antibiotic administration.
Setting:
Acute inpatient rehabilitation.
Results:
Given the long-term prognosis and patient status, discussions
regarding hospice care were held. Concurrently, treatment for auto-
immune encephalitis was initiated with high dose methylprednisolone.
The patient’s mental status and right sided weakness improved. She
initially was a max assist for all mobility and activities of daily living. At
discharge her functional status reached modified independence.
Discussion:
Cases have been reported associating combined immune
checkpoint inhibitors with autoimmune encephalitis. Immune check-
point inhibitors include nivolumab and ipilimumab. This class of che-
motherapeutics targets PD-1 and PD-L1 receptors augmenting immune
response to cancer cells. Autoimmune encephalitis may present simi-
larly to paraneoplastic encephalitis. However, autoimmune encepha-
litis is reversible while paraneoplastic encephalitis may be refractory
to immunosuppressive therapies. Other etiologies of altered mental
status and weakness to be considered in a cancer patient with brain
metastases include: infectious, tumor progression, radiation necrosis,
radiation reactivation, peritumor edema, hemorrhage, and metabolic
abnormalities.
Conclusions:
Altered mental status in the setting of brain metastasis
has a broad differential. Treatable causes of confusion and weakness
must be thoroughly considered before deciding that these symptoms
are irreversibly related to disease progression.
Level of Evidence:
Level V
Poster 172:
Functional Outcomes of Patients After Bilateral Lung
Transplant: A Case Series
Aaron L. Cross, DO (Jackson Mem Hosp/Jackson Hlth Sys),
Seema R. Khurana, DO
Disclosures:
Aaron Cross: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
The medical charts of patients admitted
to inpatient rehabilitation following bilateral lung transplant were
retrospectively reviewed. Information was extrapolated from the
charts and further analyzed, including: patient demographics, length
of hospital stay in inpatient rehabilitation, admission and discharge
Functional Independence Measure (FIM) scores, and information about
the physical therapy (PT) and occupational therapy (OT) interventions.
Setting:
Inpatient rehabilitation hospital.
Results:
Patients had a total mean inpatient rehabilitation stay of
21.66 (SD 13.42) days. Mean total FIM score at admission was 60.33
[range 53.00-68.00; SD 7.50], while the mean total FIM score at
discharge increased to 99.00 [range 90.00-104.00; SD 7.81]. Mean
motor score had the greatest increase from admission to discharge
while mean cognitive score did not greatly change from admission to
discharge. PT and OT interventions patients underwent are further
described, with a mean number of 14.00 PT treatment sessions [range
6.00-27.00; SD 11.35] and a mean number of 15.33 OT treatment
sessions [range 6.00-31.00; SD 13.65].
Discussion:
This is the first case series, to our knowledge, which
reports the functional outcomes of patients following inpatient
rehabilitation after bilateral lung transplant.
Conclusions:
Patients are able to make functional gains during
inpatient rehabilitation following bilateral lung transplant as demon-
strated by increased FIM scores from admission to discharge.
Level of Evidence:
Level V
Poster 173:
Chronic Low Back Pain, Not Necessarily a Lumbar
Etiology: A Case Report
David Her, MD (SUNY Upstate Med Univ/Syracuse),
Andreea D. Nitu-Marquise, MD, Xiaoli Dong, MD, FAAPMR
Disclosures:
David Her: I Have No Relevant Financial Relationships To
Disclose
Case/Program Description:
A 59-year-old woman had a 15-year
history of progressively worsening low back pain radiating to her right
anterior thigh. Multiple lumbar spine image studies over the years
including X-ray, CT, and MRI scans showed multilevel lumbar degen-
erative disc disease with mild spinal stenosis. One year prior to
admission, the patient noticed episodes of urinary incontinence. Three
weeks prior to admission, patient experienced further worsening of
back pain, bilateral leg weakness, and urinary incontinence. Thoracic
spine MRI revealed a T11-T12 very large calcified disk herniation
causing significant compression and distortion of the spinal cord. The
patient was urgently admitted to the hospital and underwent T11-L1
decompression and fusion. Postoperatively, patient was graded as T11
ASIA C SCI (Spinal Cord Injury) with neurogenic bladder and bowel.
Patient required total assistance with transfers, bed mobility, and
ADLs involving the lower extremities.
Setting:
Tertiary Care Hospital.
Results:
Patient was admitted to an acute inpatient rehabilitation
facility and underwent comprehensive therapies consisting of
muscular strengthening, neuromuscular reeducation via neuromus-
cular electrical stimulation, and balance/gait training including use of
mobile robot. Within 4 weeks post-admission, patient was modified
independent with transfers, ambulation, stairs, ADLs, and had reso-
lution of neurogenic bladder and bowel.
Discussion:
Myelopathy secondary to disc herniation is less common in
the thoracic spine as compared with the cervical or lumbar spine.
Symptomatic herniated thoracic discs account for 0.15
e
1.8 % of all
intervertebral disc abnormalities treated surgically. The variable
symptoms and low suspicion level complicate diagnosing process and
potentially lead to delays in treatment.
Conclusions:
Clinicians should consider thoracic myelopathy as a po-
tential differential diagnosis in patients with chronic back pain and
presence of upper motor neuron signs. This case also emphasizes that
prompt surgical intervention and appropriate rehabilitation play key
roles in improving the functional outcome of thoracic myelopathy.
Level of Evidence:
Level V
S187
Abstracts / PM R 9 (2017) S131-S290