S192 S290
these patients. To the authors’ knowledge, this is the first report of
bipolar osteochondral allograft transplantation to the ipsilateral knee
of a transtibial amputee.
Conclusions:
Osteochondral allograft transplantation may be consid-
ered as a viable treatment option for osteochondral defects within the
ipsilateral knee of transtibial amputee.
Level of Evidence:
Level V
Poster 187:
Drop Attacks in an Alcoholic: A Case Report
Molly E. Schill, DO (Vidant Rehab Ctr/East Carolina Univ/Brod),
Clinton E. Faulk, MD, FAAPMR
Disclosures:
Molly Schill: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 67-year-old man with past medical
history of alcohol abuse and multiple falls presented to inpatient
rehabilitation with an L1 burst fracture status post revision anterior/
posterior fusion. While working with physical therapy (PT) and occu-
pational therapy (OT), he continued to suffer from severe orthostatic
hypotension, dizziness, diplopia, and blurred vision with postural
changes. Neurology recommended further work up. Computed to-
mography angiography of his neck revealed severe bilateral vertebral
artery stenosis supporting a diagnosis of vertebrobasilar insufficiency.
His sudden falls, initially thought to be due to alcohol intoxication,
were actually drop attacks from vertebrobasilar insufficiency. He was
started on dual antiplatelet therapy.
Setting:
General Inpatient Rehabilitation Center.
Results:
With the known diagnosis of vertebrobasilar insufficiency and
risk of drop attacks, treatment plans were further individualized. PT
provided exercises to improve his dynamic and static balance. OT
focused on activities of daily living from supine and seated positions.
His orthostatic hypotension improved with the addition of compression
stockings, abdominal binder, and slowing of postural changes. By
discharge, patient was supervision to contact guard assist with most
mobility and had not suffered any further falls.
Discussion:
Vertebrobasilar insufficiency causes symptoms by
decreasing blood flow to the posterior circulation of the brain and is
much less common than anterior circulation syndromes. Usually eti-
ology is atherosclerosis. Surgical access to the posterior brain is
challenging making morbidity/mortality rates high; therefore, most
cases are treated with antiplatelet therapy or anticoagulation.
Conclusions:
Vertebrobasilar insufficiency should be considered in
patients with complaints including vertigo, ataxia, dizziness, syncope,
drop attacks, and visual disturbances with postural changes. Therapies
can be tailored toward these symptoms to help restore and maintain
patients’ function.
Level of Evidence:
Level V
Poster 188:
Asymmetric Upper Extremity Weakness and
Paresthesiae as the Initial Presenting Symptoms of
Guillain-Barre´ Syndrome: A Case Report
Christopher J. Rizik, DO (Wm Beaumont Hosp, Royal Oak, MI, United
States)
Disclosures:
Christopher Rizik: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
A 57-year-old man with uncontrolled
diabetes mellitus presented to the emergency department with
weakness and paresthesiae involving the hands and feet that started
several days prior. He had first noted transient proximal left shoulder
pain that gave way to profound weakness diffusely throughout the left
upper extremity (LUE). Physical medicine and rehabilitation was
consulted for electrodiagnostic analysis.
Setting:
Electrodiagnostic Laboratory.
Results:
On physical exam, he demonstrated weakness and decreased
sensation distally in the upper and lower extremities, and pronounced
weakness in the proximal LUE. Reflexes were graded 0+ in the lower
extremities, and 2+ in the upper extremities. Initial nerve conduction
studies (NCS) demonstrated abnormal median sensory and motor nerve
studies. Left tibial F-wave showed 100% penetrance. There was no evi-
dence of denervation on Electromyography (EMG) analysis. Electro-
diagnostic impression was of bilateral carpal tunnel syndrome, and
demyelinating and axonal peripheral polyneuropathy. He returned to
the hospital several days later with worsened weakness in the same
distribution, and was started on intravenous immunoglobulin (IVIG) for
presumed Guillain-Barre´ syndrome. Repeat NCS/EMG completed 7 days
after the initial study demonstrated slightly improved median sensory
and motor nerve studies. Left ulnar and median F wave studies showed
30 and 40% penetrance, respectively. Needle analysis demonstrated
denervation diffusely throughout the left upper and lower extremities.
Subsequent impression was of demyelinating peripheral neuropathy
consistent with Guillain-Barre´ syndrome.
Discussion:
This patient presented with an unusual pattern of weak-
ness and paresthesiae that was eventually attributed to Guillain-Barre´
syndrome. Given early presenting shoulder pain, a diagnosis of
neuralgic amyotrophy was considered; however, the diffuse presen-
tation in multiple extremities made this diagnosis unlikely. The patient
completed an IVIG course, and was transferred to inpatient rehabili-
tation for intensive therapy efforts.
Conclusions:
We report a case of Guillain-Barre´ syndrome with un-
usual presenting symptoms including diffuse, asymmetric upper ex-
tremity weakness and paresthesiae.
Level of Evidence:
Level V
Poster 189:
Chondromyxoid Fibroma of the Ilium Requiring Wide
Resection: A Case Report
William S. Raoofi, MD; (SUNY Upstate Medical University, Syracuse,
New York, United States), Travis Coats, MD, MPH, Willilam S. Raoofi,
MD, Diya Goorah, MD, Carlos Marrero Prats, MD, David Kanter, MD,
Margaret A. Turk, MD
Disclosures:
William S. Raoofi, MD: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
The patient is a morbidly obese 35-year-old
womanwho presentedwith a 6-month history of right flank and hip pain. CT
and MR imaging revealed a lytic lesion in the right iliac wing with extension
through the posterior cortex and into the surrounding soft tissues of the
right gluteal region. Biopsy results were consistent with chondromyxoid
fibroma (CMF). Definitive treatment resulted in awide resection of the right
iliac wing and en bloc resection of a nearby right gluteal soft tissue mass.
Setting:
Acute inpatient rehabilitation hospital.
Results:
Due to significant bone and muscle resection, an aggressive
multi-modal pain management approach was necessary to facilitate
the patient’s participation in therapy. Therapeutic exercises were
focused on strengthening hip abductors, extensors, and flexors to
improve pelvic stability.
Discussion:
CMF is one of the rarest benign bone tumors accounting
for less than 0.5% of all bone tumors. Although it is benign, it can
present similarly to more aggressive bone tumors such as chondroma,
giant cell tumor, and chondrosarcoma both clinically and on imaging.
This case of CMF was atypical due to its location as most cases of CMF
occur in the proximal tibia, distal femur, and calcaneus. Furthermore,
the differential diagnosis of most bone lesions rarely includes CMF
when they occur in places other than the proximal tibial metaphysis.
Conclusions:
CMF is an uncommon bone tumor with very few case re-
ports of it occurring in the pelvis. Clinicians should consider CMF as a
possible diagnosis when evaluating pelvic bone lesions as it may mimic
other more aggressive pathologies in clinical presentation and imaging
characteristics.
Level of Evidence:
Level V
S192
Abstracts / PM R 9 (2017) S131-S290