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presented for rehabilitation following prolonged hospital stay for
respiratory failure. The patient required tracheostomy placement.
Setting:
Acute inpatient rehabilitation.
Results:
His stay was complicated by multiple episodes of tracheal
dislodgment related to body habitus and sizing. Emergent transfers
occurred in each instance. Characteristic morphologic differences in
this patient with Klippel-Feil syndrome included craniofacial and spinal
deformities with congenital absence of left nostril, scoliosis, and a short
neck. These congenital deformities required consideration during epi-
sodes of respiratory compromise. He had multiple facial reconstruction
surgeries as a child. The trach was replaced multiple times and place-
ment maintained using a size 6.0 XLT distal flexible trach.
Discussion:
Klippel-Feil syndrome is characterized by congenital fusion
of cervical vertebrae. This anomaly is associated with limited neck
extension and rotation. Klippel-Feil syndrome has associationwith other
phenotypic characteristics including scoliosis, short neck, low hairline,
Sprengel’s deformity, cardiac abnormalities, and facial anomalies.
Respiratory failure in these patients may be multifactorial. Anomalies
may lead to the inefficacy of typical approaches during an event of
respiratory compromise. Developmentally non-patent nares limit use of
a nasal cannula for oxygen supplementation. Limited neck extension
leads to difficult visualization of the larynx during traditional intubation.
Conclusions:
In the rehabilitation setting, Klippel-Feil syndrome pre-
sents a challenge to approaches relying on typical anatomy for posi-
tioning, therapy, and procedures. Vertebral anomalies with cervical
fusion and limited rotation and extension are characteristic, however
other patient specific and associated anomalies must be considered for
proper management during acute events. Those with Klippel-Feil syn-
drome and respiratory failure are a unique group benefitting from a
targeted approach to rehabilitation when scoliosis, obesity, and
deconditioning are major factors contributing to functional decline.
Level of Evidence:
Level V
Poster 222:
A Rare Case of a Massive Bilateral Pulmonary Embolism
After Routine Knee Arthroscopy: A Case Report
Samuel S. Murala (Montefiore Medical Center/Albert Einstein, Bronx,
NY, USA), Francis J. Lopez, MD
Disclosures:
Samuel Murala: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 53-year-old woman with no significant
medical or surgical history underwent routine arthroscopic surgery to
repair a meniscal tear in her left knee. A day after the procedure she
developed severe shortness of breath and presented to the emergency
department (ED). In the ED she was found to be tachycardic, hypoxic and
hypotensive and subsequently diagnosed as having a massive pulmonary
embolism (PE) and was admitted to Intensive Care Unit and ultimately
underwent catheter directed thrombolysis. Once she was hemodynami-
cally and medically stable, she was transferred to the acute inpatient
rehabilitation unit for functional optimization with oral anti-coagulation.
Setting:
Acute Inpatient Rehabilitation Unit.
Results:
Lung spiral CT scan revealed large clot burden extending
from the distal right and left main pulmonary arteries bilaterally to
segmental and subsegmental branches, occlusive and nonocclusive
along with elevated troponins. Her hypercoagulability workup was
negative for all thrombophilic syndromes including antiphospholipid,
anti-cardiolipin syndromes as well as lupus.
Discussion:
Pulmonary embolism following arthroscopic surgery is a
very rare complication. One study placed the incidence of such events
at just 2.8 cases per 10,000. However, there remains limited data
describing the rarity this event.
Conclusions:
Though pulmonary embolism after arthroscopic surgery
is an extremely rare event, it is extremely important for physiatrists
and primary care practitioners to be cognizant of this serious and
potentially fatal complication.
Level of Evidence:
Level V
Poster 223:
Management of Man with Recurrent Intradural
Extramedullary Metastasis from Breast Cancer
Causing Progressive Lower Extremity Weakness and
Paresthesias: A Case Report
Yodit Tefera (New York Presbyterian Hospital Columbia and Cornell),
Akinpelumi Beckley, MD, Wade O. Johnson, DO
Disclosures:
Yodit Tefera: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 61-year-old man with Stage IV HER2/NEU
breast cancer presented to a tertiary care facility with bilateral lower
extremity weakness which began approximately 4 weeks prior with acute
progression prompting presentation. He was initially diagnosed with
breast cancer in 2004 and received treatment including chemotherapy,
radiation, and Tamoxifen therapy. In June 2015, he developed weakness
in his lower extremities and ambulatory difficulties. Found to have a
metastatic lesionwarranting T8 corpectomy and thoracic laminectomy to
be followed by radiation and chemotherapy. The patient presented 15
months later with left lower limb weakness and paresthesia. He had a
progressive loss of proprioception, sensation and ambulation over the
course of 3 weeks. CT myelogram and MRI completed demonstrated a
recurrence of his metastatic disease from T6-T10 and intradural lesions
present at S1-S2. He underwent revision thoracic decompression and
tumor resection. Post-surgery the patient continued to have lower ex-
tremity weakness, paresthesias, numbness, and incontinence necessi-
tating acute rehabilitation and adjuvant therapy.
Setting:
Tertiary care hospital.
Results:
The neurological manifestations the patient presented with
are characteristic of acute spinal cord compression. Neuropathic pain
was a predominant complaint from the patient during hospital course.
Discussion:
Breast cancer in men is rare, representing 1% of total
breast cancer cases worldwide. Spinal cord injury in the setting of
breast cancer in males is even more rare and review of this case also
brings attention to the natural progression and symptoms of thoracic
myelopathy.
Conclusions:
It is important to recognize neurological changes in pa-
tients with history of malignancy in order to diagnose and treat met-
astatic disease. Rehabilitation is important in the management of
these patients with acquired spinal cord injury.
Level of Evidence:
Level V
Poster 224:
An Unusual Case of Pulmonary Embolism in a Stroke
Patient: A Case Report
Ashley Simone Maybin, MD (Vanderbilt Univ Med Ctr)
Disclosures:
Ashley Simone Maybin: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
A 56-year-old African Americanman with a
past medical history of hypertension and hyperlipidemia was admitted
to inpatient rehabilitation for impaired mobility, self-care, and gait
dysfunction status post-acute infarct in his left middle cerebral artery
and posterior cerebral artery distribution. He was diagnosed with
aphasia and right hemiparesis. Hewas progressingwith his rehabilitation
when suddenly he showed signs of abdominal discomfort. He was not
able to communicate details but gestured. The patient had no nausea or
emesis and vital signs were stable. Due to this acute change in pain, the
patient was transferred for further evaluation.
Setting:
Inpatient Rehabilitation.
Results:
Patient was evaluated in the Emergency Department 1 hour after
his initial symptoms. Focused physical examination was notable for upper
abdominal pain radiating down toward his umbilical region. His exam was
also positive for guarding. CT of his abdomen and pelvis revealed no evi-
denceof acute intra-abdominal pathology, however therewas an incidental
finding of a pulmonary embolus in his right lower lobe. Radiology
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