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recommended CT of the patient’s chest. CT angiogram was performed
revealing bilateral lower lobe subsegmental pulmonary emboli.
Discussion:
This case report demonstrates a man with severe aphasia
status post stroke who developed pulmonary emboli with presenting
symptom of abdominal pain. Fortunately, the patient received urgent
medical intervention of enoxaparin, bridged to warfarin. He remained
stable and his abdominal pain subsided within 24 hours. The patient
had a positive outcome as a result of high suspicion when communi-
cation was a barrier.
Conclusions:
In this case it was key to identify this patient’s abdominal
pain as a sign of amedical problemwhich required evaluation, especially
given the patient’s difficulty communicating. Acute onset abdominal
pain should be considered a rare, but possible, sign of pulmonary em-
bolism, even if no other common pulmonary embolism signs are present.
Level of Evidence:
Level V
Poster 226:
Neurogenic Bladder and Acute Inflammatory
Demyelinating Polyneuropathy Following Herpes
Simplex Virus Infection: A Case Report
Hugh T. McDermott, MD (UIC Com, Naperville, IL, United States)
Disclosures:
Hugh McDermott: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
A 68-year-old man originally presented
with urinary retention and leg weakness. Two weeks prior to presen-
tation he had genital herpes which had cleared. His weakness pro-
gressed to inability to ambulate or stand. Foley was placed in ED. MRI
lumbar spine with enhancement of conus and lumbar nerve roots most
compatible with inflammatory myelitis. Normal leukocyte count. CSF
with lymphocytic pleocytosis (WBC 150, 95% lymphocytes, Protein 197,
Glucose 49), and it was positive for HSV. Was started on acyclovir and
methylprednisolone. Ascending paralysis continued and he required
intubation for 7 days due to respiratory compromise. Completed one
IVIG and then six plasmapheresis treatments. Quadraparesis gradually
improved to upper extremities but continued to have urinary retention
and lower extremity paralysis. With aid of physical therapy, exoskel-
eton, and zero gravity device he was able to ambulate and transfer at a
moderate independent level. Urinary retention resolved after course of
Urecholine, Cardura, and tamsulosin which he no longer requires.
Setting:
Acute inpatient rehab.
Results:
No new laboratory or imaging studies performed in acute
rehab. Urinary retention resolved. Eventually, he was able to ambu-
late with assistive device.
Discussion:
After literature search, this author was only able to find
one example of herpes simplex virus being antecedent to GBS. Most
cases involve campylobacter, HIV, EBV, and more recently Zika virus.
Additionally, the patient had significant dysautonomia most notably his
urinary retention. He also had fluctuating hypertension and hypoten-
sion requiring medical management throughout his rehab stay.
Conclusions:
While not commonly recognized, based on this case,
herpes simplex virus could be considered as a possible antecedent to
acute inflammatory demyelinating polyneuropathy. More research into
this topic and suggested causality is required.
Level of Evidence:
Level V
Poster 227:
Thoracic Myelopathy in a Man due to Severe Spinal
Stenosis Caused by Epidural Lipomatosis Presenting
with Paraplegia, Paresthesia, and Bowel and Bladder
Urgency: A Case Report
Michael Chu (Tufts Medical Center Physical Medicine a, Boston, MA,
USA), Damon Gray, MD, Vidya Jayawardena, MD
Disclosures:
Michael Chu: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
A 64-year-old man with past medical history
of obesity, hepatic cirrhosiswithchronic hepatitis C,diastolic heart failure,
hypothyroidism, congenital absence of left kidney, benign prostate hy-
pertrophy, post-traumatic stress disorder, nicotine dependence, erectile
dysfunction and chronic low back pain. In December 2015, the patient
presented with lower trunk and bilateral lower extremity pain, paresthe-
sias, and urgency of bowel and bladder. In February 2016, he began to
develop significant lower extremity weakness, requiring a cane to ambu-
late. Initial lumbar CT in April 2016 did not reveal any significant pathology.
He underwent further workup, including a thoracicMRI inAugust 2016, that
revealed severe stenosis from levels T4-8 due to epidural lipomatosis. The
patient’s ambulation status continued to deteriorate, and by October, he
was only able towalk 10 ftwithawalker before needing rest. He underwent
T4-T8 laminectomy and fusion in December and the diagnosis of epidural
lipomatosis was confirmed intraoperatively. Post-operatively, he was
admitted for acute rehabilitation.
Setting:
Tertiary care Veterans Affairs hospital.
Results:
The patient participated in acute rehabilitation for 2.5 weeks
and he made significant improvement in lower extremity motor
strength and motor planning, and was able to improve his ambulation
from requiring moderate assistance to attaining modified indepen-
dence with a rollator at time of discharge. His initial post-surgical total
lower extremity motor function score was 32/50 which improved to
46/50 after the 2.5 week course of rehabilitation.
Discussion:
This case is a rare presentation of mid thoracic idiopathic
epidural lipomatosis in a patient with no history of excess endogenous
or exogenous steroids.
Conclusions:
Epidural lipomatosis is a rare cause of spinal stenosis
that can cause significant progression of neurological deficits. This
diagnosis can be identified by MRI and has a good prognosis of recovery
after surgical decompression and acute rehabilitation.
Level of Evidence:
Level V
Poster 228:
Multiple Congenital Limb Deficiencies
.
Finding the
Missing Pieces through Physiatric Interventions: A
Case Report
Ma Nessa B. Gelvosa, MD (Veterans Memorial Med CntrDept of Rehab),
Alex Zander A. Bondoc, MD, PTRP
Disclosures:
Ma Nessa Gelvosa: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
This report presents the case of a 16-year-
oldmale who was born withmultiple congenital limb deficiencies and the
rehabilitative interventions done that improved the patient’s overall
functional capacity. The patient, initially seen at 6 years of age, pre-
sentedwithhypoplastic handswith contracted left elbowand absent right
foot. Radiographs of the hands show fused and deficient carpals, absent
central rays, and a single developed finger on each hand. On the right
lower extremity, there was a transverse deficiency of the right foot with a
probable underdeveloped calcaneus, absence of all other tarsals, 1st-5th
metatarsals and their corresponding phalanges. Patient had an undesir-
able gait pattern with stooped posture at risk for musculoskeletal com-
plications. He was fitted with a Modified Syme’s prosthesis, which
included a SACH foot and a socket serving as shank with anterior opening
and Velcro straps. Addition of ankle block was done for his succeeding
prostheses to adjust for his growth. His latest prosthetic appliance was
modifiedwith an additional proximal patellar-tendon bearing component
due to skin ulcerations on the distal stump. Intensive physical therapywas
done for gait retraining, as well as occupational therapy for further
improvement of ADLs using his residual upper extremities.
Setting:
Tertiary government hospital in a developing country.
Results:
Patient became an unlimited community ambulator with
corrected gait and good acceptance of the prosthesis. He has achieved
modified independence in all ADLs.
Discussion:
Congenital limb deficiency roughly affects 7.9 million
newborns every year. A number of patients usually have combined
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Abstracts / PM R 9 (2017) S131-S290