Monica Verduzco-Gutierrez

Poster 276: Anxiety and Panic Disorder Following Intrathecal Baclofen Pump Placement: A Case Report

trauma or recent infections and stated that he was using his arms without any weakness or pain the night before. ED workup was negative for stroke and labs were unremarkable. Patient was admitted for further workup. Setting: Tertiary Care Center Results: Neurology was consulted for recommendations. Leading diagnosis was central cord syndrome vs brachial plexopathy. Repeat MRIs of C-spine and brachial plexus were performed. Possible infectious or autoimmune markers including Lyme, RPR, HIV, ANA, SED rate were assessed. CSF was analyzed. NCS revealed reduced amplitudes in right median innervated muscles and bilateral ulnar motor muscles. EMG showed diminished recruitment and interference patterns. The patient was administered IV corticosteroids and the next day began regaining strength in his proximal muscles with improvement in shoulder abduction. Discussion: Idiopathic brachial plexopathy aka neuralgic amyotrophy is rare with an estimated incidence of 1.64:100,000. Of those, 29% are bilateral and only 15% are painless; making the overall incidence for this patient’s presentation 1:1,300,000. Conclusions: Idiopathic brachial plexopathy typically presents with acute pain that progresses to paresis. The timing of weakness is variable, from 24 hours after pain onset to 2 weeks. Treatment is controversial and no studies have shown steroids or IVIG to be statistically helpful. This situation was unusual in the acuity of the symptoms as well as the atypical presentation and the immediate response to steroids. Electrodiagnostic studies were not helpful in this case due to the acuity of the disease, but serial studies would be recommended to follow progression. Level of Evidence: Level V

Poster 24: Gender and Ethnic Diversity Among PM&R Residency Applicants

Participants: n/a Interventions: n/a Main Outcome Measures: n/a Results: Grey-scale ultrasound is consistently reported as an effective and user-friendly imaging modality for the patellar tendon, with specificity and sensitivity equivalent to or greater than MRI in the diagnosis of patellar tendinopathy. The ultrasound exam may gain accuracy when supplemented with color Doppler imaging, but at this time no evidence exists to indicate the use of elastographic imaging for patellar tendinopathy. Also, findings are mixed concerning the accuracy of ultrasonographic measurement of the patellar tendon. Conclusions: Given the high and growing costs of musculoskeletal MRI imaging in the United States and promising preliminary findings in MSK ultrasound, we recommend that ultrasound may be selectively substituted for MRI in cases of patellar tendinopathy. Barriers to the implementation of MSK ultrasound revolve mainly around education and competence. To the experienced operator, MSK ultrasound may represent a powerful, cost-efficient bedside diagnostic tool. Level of Evidence: Level IV

Poster 81: PM&R Consults for Combined TBI/SCI Patients in the Shock Trauma ICU Impact Ventilation Days, Morbidity, and Disposition: A Retrospective Study

electromyography, electrical stimulation and ultrasound), electromyography was the most frequently used (39.5%e61.5% of treatment sessions). Across all treatments, 91.1% of physicians and 82.3% of patients reported being satisfied or extremely satisfied that treatment helped manage spasticity; 84.6% of physicians and 74.8% of patients reported that the treatment benefit was sustained, and 97.4% of physicians and 89.8% of patients would definitely or probably continue onabotulinumtoxinA. 28.0% (n1⁄4205) of patients reported 1 adverse event (AE) and 10.3% (n1⁄475) reported a serious AE. No new safety concerns were identified. Conclusions: One-year results demonstrate the safety and effectiveness of onabotulinumtoxinA for spasticity in clinical practice. Further analyses will explore clinical and burden outcomes and differences across etiology and presentation. Level of Evidence: Level IV

Poster 76: PMR Consults Impact Disposition for Brain Injury Patients with a Prolonged Shock Trauma ICU Stay: A Retrospective Study

Disclosures: Jacob Moore: I Have No Relevant Financial Relationships To Disclose Objective: To develop predictive scales in pediatric patients with Charcot-Marie-Tooth (CMT) that correlate changes in the CharcotMarie-Tooth neuropathy score (CMTNS) with type of ambulatory aid used. Design: This is a retrospective cross-sectional study. Data collected included demographics, CMTNS, type of ambulatory aid used, foot surgery, difficulty with buttons, and difficulty with eating utensils. Mean scores and standard deviations for CMTNS were calculated for every ambulatory aid used to develop predictive scales. Setting: An integrated group of academic medical centers. Participants: 625 patients, 270 male and 269 female, who were consented through the Inherited Neuropathy Consortium as part of the natural history clinical registry trial [NCT01193075] were assessed in this study, and of these, 539 were included in the analysis. Mean age was 13 years old, range 8-18, SD 2.9. 84% of the patients were Caucasian. Interventions: Not applicable. Main Outcome Measures: Not applicable. Results: There was a strong correlation between ambulatory aid used and CMTNS score (0.63, p < .0001); smaller correlations were seen between ambulatory aid used and foot surgery (0.16, p 1⁄4.007), buttons (0.31, p < .0001) and eating utensils (0.33, p < .0001). No ambulatory aid use and minimal (shoe inserts, custom shoes, nightsplints) ambulatory aid use had equivalent mean CMTNS at 8.4. Mean CMTNS for use of one or more of the following ambulatory aids: supramalleolar orthosis (SMO), supramalleolar ankle foot orthosis (SMAFO), ankle foot orthosis (AFO), molded ankle foot orthotics (MAFO), Arizona brace was calculated at 10.5. Mean CMTNS for using a wheelchair or scooter was 23. Conclusions: We have identified predictive scales that correlate CMTNS values with progressive functional needs. We recommend prospective validation of our predictive scales in a CMT clinic population. Level of Evidence: Level II

Poster 260 The Rehabilitative Management of a Patient with Anti-N-methyl-D-aspartate Receptor Encephalitis: A Case Report

propranolol initiated during inpatient rehabilitation. However, patient continued to report insomnia, profuse night sweats and fatigue. Setting: Acute Rehabilitation Hospital. Results: Following initiation of tizanidine at bedtime, her night sweats resolved and she was able to sleep through the night. She also reported significant improvement in fatigue. Blood pressure remained stable while on tizanidine. Discussion: Tizanidine is a centrally acting alpha-2 adrenergic receptor agonist that is typically used to treat spasticity. We propose tizanidine may inhibit the increased sympathetic activity that is responsible for causing night sweats in this patient by decreasing norepinephrine release via its alpha-2 adrenergic receptor agonist activity. Literature review reveals sparse reports on this topic with regards to neurological disorders. Conclusions: Initiation of tizanidine resulted in improved sleep and significantly reduced night sweats in a patient with dysautonomia due to cervicothoracic syrinx status post craniotomy. This case raises the question if tizanidine may be effective in treating night sweats associated with other conditions as well as other symptoms associated with autonomic dysfunction and warrants further study. Level of Evidence: Level V

Poster 237 Bilateral Hip Fracture During Hospitalization for Spasm Exacerbation in an Adult with Stiff Person Syndrome: A Case Report.

extremity weakness persisted and he was discharged with a power wheelchair. Discussion: Cocaine-induced spinal cord infarctions are rare, with few documented cases. The pathogenesis of spinal cord infarct remains poorly understood, but may include hypertension, vasoconstriction, thrombosis, and vasospasm. Similarly, prognosis is difficult to assess. In our case, the patient’s underlying copper and zinc deficiencies may have limited his recovery. Copper and zinc are essential cofactors for the functioning of superoxide dismutase, an antioxidant with neuroprotective and neurorestorative properties. Decreased levels of superoxide dismutase are associated with worse outcomes following stroke. Conclusions: Copper and zinc deficiencies may predispose to spinal cord infarct and can worsen outcomes following spinal cord injury. Screening and adequate repletion may facilitate recovery. Malnourished individuals, such as drug users, are at increased risk for these deficiencies. Further studies are required before definitive recommendations for repletion can be made. Level of Evidence: Level V

Poster 345 Rehabilitation of Bickerstaff Brainstem Encephalitis: A Case Report

completing comprehensive rehabilitation, including vestibular therapy, the patient was discharged home independent in ADLs and ambulating with a cane. One month later he presented with new-onset dysphagia, and worsening of left facial numbness and dizziness. A brain MRI confirmed acute left inferior cerebellar peduncle and lateral medullary infarct. Discussion: This patient initially presented with concern for occult central neurologic injury, but peripheral vertigo. We suspected left posterior cerebral circulation insufficiency including Anterior Inferior Cerebellar Artery (AICA). It was not until the second stroke that brain imaging confirmed clinical diagnosis. Conclusions: 1. Clinical evaluation remains the gold standard to diagnose stroke. 2. Patients with posterior circulation stroke might have vertigo of central or peripheral origin if the AICA is involved. Diagnosing uncompensated vestibular weakness, along with timely implementation of vestibular rehabilitation therapy has been proven to improve recovery and morbidity outcomes. Level of Evidence: Level V

Poster 300 Spontaneous Spinal Epidural Hematoma of the Thoracic Spine: A Case Report

adverse events (AEs) included dysphagia and muscle weakness. Five patients discontinued due to AEs. Conclusions: This study demonstrates the usual clinical practice of botulinum toxin injectors across multiple sites and demonstrates a consistent approach to abobotulinumtoxinA injection patterns and doses. Use of EMG guidance was variable, with less than half of the injections using this technique. Level of Evidence: Level II

Poster 249 Remarkable Recovery of Function in a Young Adult Female after Low-Velocity Penetrating Head Injury and Arrival with Retained Foreign Body: A Case Report

a 23-year-old woman with chronic right lower quadrant abdominal pain starting months following a motor vehicle crash. She reported no abdominal pain or other injury immediately post accident. Point of maximal tenderness localized in the region of right rectus abdominis with EMG findings similar to Patient 1. She received 100 units ONA in this region with symptom relief for up to 4 month periods. Setting: Spasticity clinic in a tertiary care center. Results: These 2 cases illustrate focal post-traumatic abdominal wall pain, clinically diagnosed as post-traumatic focal dystonia, that was responsive to treatment with ONA. Patients noted greater degree and longer duration of improved symptoms than with prior treatments, and each decreased oral medication utilization. Discussion: ONA has been shown to effectively manage the most common focal dystonias. Focal abdominal dystonia has rarely been reported in the literature. These cases illustrate effective treatment of post-traumatic, focal abdominal dystonia with ONA. Conclusions: Effective management of refractory, post-traumatic abdominal pain secondary to focal dystonia is possible through treatment with ONA. Level of Evidence: Level V

Is There a Need for Early Seizure Prophylaxis After Traumatic Brain Injury

You are the consulting physiatrist of a busy surgical intensive care unit (ICU) at a large, urban academic medical center. You are part of a Pharmacy and Therapeutics Ad Hoc Subcommittee charged with exploring all “routineeper protocol” use of medications in the ICU. Your charge is to critically assess these types of medications from the perspective of both safety and expense. One of the categories the Subcommittee is charged with reviewing is the routine use of seizure prophylaxis in the first week after traumatic brain injury (TBI). Data provided by the finance department have indicated that there has been a steady trend during the past 3 years to use levetiracetam rather than phenytoin as the prophylactic agent of choice in the first days to weeks after TBI. The financial ramification of this trend has been significant, to the magnitude of