David L. Nash

Knowledge of signs, treatment and need for urgent management in patients presenting with an acute ischaemic stroke or transient ischaemic attack: A prospective study

Objective: To assess stroke awareness among patients presenting to the emergency department with an acute ischaemic stroke or transient ischaemic attack (TIA). Methods: A consecutive cohort of patients presenting with a cerebrovascular event was prospectively enrolled over a 15-month period and questionnaires were administered. If the patient was unable to respond to the questions or answer the questionnaire, it was administered to the primary caregiver. Comprehension of having a cerebrovascular event, reason for delay in presentation, mode of arrival and knowledge of treatment modalities were determined. Results: Only 42% of 400 patients thought they were having a stroke or TIA. The median time to presentation was 3.4 h. Delayed presentation was almost equal in men and women. When asked about onset, 19.4% thought that a stroke came on gradually and only 51.9% thought immediate presentation was crucial. 20.8% of patients had heard of thrombolysis. Conclusion: Community knowledge of ischaemic stroke needs to be enhanced so that individuals present earlier, leading to timely management.

Complications and management of ventriculoatrial (VA) shunts, a case report

Background An 18 year old female with history of myelomeningocele and hydrocephalus had her ventriculoperitoneal shunt converted to a VA shunt following development of peritonitis at age 11 years. Seven years later she was admitted with abdominal pain. CT revealed a perihepatic abscess and incidental right lower lobe pulmonary embolus (PE). Further investigation revealed a large right cardiac ventricle thrombus. She underwent open thrombectomy and was anticoagulated. Pathologic evaluation of the thrombus demonstrated focal purulent inflammation without identifiable organisms.

Poster 391 Beauty Isn’t Necessarily Benign: Minocycline-Induced Vasculitic Neuropathy with Central and Peripheral Involvement – A Case Report

Discussion: Despite similar oncologic diagnoses and tumor site, all patients had variable presentations and functional needs. Further discussion on their presenting symptoms, advanced imaging, treatment challenges, and outcomes will be included in the final poster. Conclusion: Children with recent posterior fossa tumor resections demonstrate improved functional gains after admission to an acute inpatient rehabilitation unit. Specific criteria should be developed based on presentation, tumor type, and treatment pathway to determine which children would benefit most from inpatient rehabilitation.

Poster 297: Comparison of Neurogenic Bladder Management in Individuals With Repaired Myelomeningocele With and Without Tethered Cord Syndrome

Disclosures: J. E. Skinner, None. Objective: To compare individuals with a history of repaired myelomeningocele and tethered cord syndrome (TCS) status-post detethering with matched individuals who were not diagnosed with TCS. We hypothesize that those who underwent spinal cord detethering have greater urologic abnormalities and incontinence than those who did not have an untethering procedure. Design: Retrospective case cohort study. Setting: Specialty hospital. Participants: Individuals with history of repaired myelomeningocele evaluated between 1966 and 2006. Two groups matched for gender, age, time of treatment at institution, and level of impairment. Interventions: Not applicable. Main Outcome Measures: Group demographics, listing of orthopedic, urologic, and neurosurgical procedures. Comparison of urologic function and studies and orthopedic procedures between the groups was assessed using Chisquare calculations. T-test calculations were used for comparison of shunt interventions. Results: Sixteen individuals with repaired myelomeningocele and surgical spinal cord detethering and 17 individuals with repaired myelomeningocele were identified. No significant difference between the groups was noted for incidence of shunted hydrocephalus, timing and number of orthopedic surgeries. The TCS group had a mean of 5.5 shunt revisions compared with a mean of 1.4 shunt revisions in the non-TCS group (P .0001). 2/16 (13%) underwent detethering due to urologic complaints. There was no significant difference between the 2 groups with respect to bladder continence, vesicoureteral reflux, and hydronephrosis before and post detethering of the TCS group. Within the group that was detethered, there was no significant difference in bladder continence, vesicoureteral reflux, or hydronephrosis before and post detethering. Conclusions: Shunt revisions were more common in those with a diagnosis of and surgical intervention for tethered cord syndrome. Urologic complaints were not a common TCS symptom. There was no significant difference in timing or number of orthopedic procedures, urologic testing results, or bladder continence between the groups.

Neurologic recovery with conservative management in symptomatic tethered cord

Background We present a case of a male adolescent with Spina Bifida who had new gait difficulty and fatigue following a fall. On physical exam, he had new right quadriceps weakness and progression of his hip flexion contractures. Initial studies included radiographs of his lumbar spine and pelvis, which revealed no acute bony injury or a significant change of his chronic bilateral dislocated hips. Magnetic resonance imaging (MRI) of the brain, cervical spine, and lumbar spine were obtained. MRI of the brain and cervical spine showed no definitive etiology. MRI of the lumbar spine showed a small syrinx from T9 to the conus and changes suggestive of a tethered cord. Neurosurgical evaluation concluded with a diagnosis of symptomatic tethered cord and surgical release was recommended. However, the patient was hesitant to undergo surgery. On follow-up exam, he had new bilateral hip adductor weakness increasing right quadriceps weakness. Further studies included electrophysiologic testing which showed severe ongoing denervation in the right L2–L4 innervated muscles and an MRI of bilateral thighs, which did not show any abnormalities of the adductor or quadriceps muscles. While the MRI of the lumbar spine did show a low lying conus with thickened filum terminale, it did not show other significant spinal or disc abnormalities to correlate with the electrophysiologic results. He was initiated on a physical therapy program. Materials and methods This is a case presentation with a chart and literature review.