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Poster 225: Opsoclonus-Myoclonus Syndrome Associated with Hepatitis B Infection: A Case Report
PM&R
surgery, outline realistic expectations of recovery, and provide neuromuscular re-education. Keywords: Rehabilitation, Spinal cord injury, Brachial plexopathy.
Poster 224 Obesity and Disability. Paolo Capodaglio, MD (Istituto Auxologico Italiano, IRCCS, Verbania, Italy); Marco Cavigioli; Francesco Menegoni; Luca Vismara. Disclosures: P. Capodaglio, None. Objective: Obesity is frequently associated with various musculoskeletal disorders including impairment of the spine and low back pain (LBP). Chronic musculoskeletal conditions impact on the subjects’ capacity to perform daily life activities eventually leading to disability. The role of obesity in the disablement process needs further scientific evidence. The aim of our study was to provide evidence of a direct correlation between body weight and disability. Setting: Hospital-based study. Participants: 77 obese patients (BMI 41 ⫾ 7 kg/m2, age 44 ⫾ 11 years) have been selected: 53 with non-specific low back pain (nsLBP), 12 with specific low back pain (sLBP) and 12 with no pain (NP). Main Outcome Measures: Pain was measured with the VAS (0-100) scale1. Disability was measured with the Roland and Morris Disability Questionnaire (Rm) 2 and the Oswestry Low Back Pain and Disability Questionnaire (O) 3. VAS, Rm and O were considered ordinal variables, thus we used non-parametric tests: Spearman rank order correlations (P⬍.05) for the correlations and Mann Whitney U-Test for comparison between groups. Results: The strongest correlation was found between body weight and disability, as measured by O, in sLBP patients (R ⫽ 0.74, P ⫽ .005). In nsLBP a significant but lower correlation (R ⫽ .35, P ⫽ .01) was found. A significant correlation (R ⫽ .24, P ⫽ .036) was evident when all LBP patients were considered, but no correlation was found in NP obese subjects. Conclusions: Body weight appears to have a fundamental role in the onset of LBP and a direct correlation with the disablement process. Keywords: Low back pain, Disability, Obesity.
Poster 225 Opsoclonus-Myoclonus Syndrome Associated with Hepatitis B Infection: A Case Report. David Ronin, (Lutheran General Hospital, Park Ridge, IL); Lloyd S. Davis, MD; Susan Lis, MD; Amy Sun, MD. Disclosures: D. Ronin, None. Patients or Programs: We describe a case of a 44-yearold man with no significant medical history who was admitted to an acute care hospital with sudden onset of dizziness, horizontal nystagmus and truncal ataxia.
Vol. 1, Iss. 9S, 2009
S201
Program Description: Extensive work-up for underlying malignancy, collagen vascular disease and infectious process was negative. Based on clinical presentation the patient was diagnosed with opsoclonus-myoclonus syndrome (OMS). Setting: Tertiary hospital based acute care rehabilitation unit. Results: Infectious work- up was negative for cytomegalovirus, Epstein-Barr virus or HIV. The patient was started on high-dose IV steroids. Subsequently he was transferred to the rehabilitation unit of the hospital. Liver function tests were done. There was slight increase in ALT, 99 units/L. Hepatitis screen was positive for hepatitis B infection. Hepatitis B DNA viral load was high at 7.6 (42,100,000 IU/mL). Normal level is less than 1.6. Patient’s functional status significantly improved. Entecavir was going to be used to treat hepatitis B infection as an outpatient. Discussion: OMS is a rare debilitating disorder affecting children and adults. Underlying cause may involve infections or occult malignancy. Etiology of symptoms in OMS syndrome is postulated to be immune-mediated response directed against a select group of neurons. Opsoclonus is associated with impairment of pause cells in pontine reticular formation. Ataxia, truncal and limb myoclonus are due to loss of cerebellar neurons. Identification of actual microorganism in OMS is extremely rare. Reported viral infections include cytomegalovirus and Epstein-Barr virus. This is the first case, to our knowledge, of OMS associated with hepatitis B virus. Conclusions: We conclude that hepatitis B virus should be included in differential diagnosis of OMS. Early treatment may significantly improve patient’s outcome. Keywords: Rehabilitation, Opsoclonus-myoclonus syndrome, Hepatitis B virus.
Poster 226 Ovarian Vein Thrombophlebitis (OVT), a Rare Cause of Persistent Fever in the Setting of Acute Inpatient Rehabilitation: A Case Report. Sangmin Ahn, MD (Baylor College of Medicine, Houston, TX); Pari Azari; John S. Harrell, MD. Disclosures: S. Ahn, None. Patients or Programs: A 30-year-old woman with left hemiparesis secondary to a right basal ganglia hematoma due to eclampsia, status post emergent cesarean section and right frontotemporal craniotomy with evacuation. Program Description: A 30-year-old woman at 38 week gestation presented with seizures secondary to eclampsia. Seizures were controlled with magnesium sulfate but the patient sustained a left basal ganglia intracerebral hemorrhage with resultant hemiparesis. Cesarean section followed by right frontotemporal craniotomy with evacuation was emergently performed. She was transferred to inpatient rehabilitation for functional deficits related the hemiparesis. Persistent fever with leukocytosis developed on admission with unremarkable review of systems except headache and sore-
surgery, outline realistic expectations of recovery, and provide neuromuscular re-education. Keywords: Rehabilitation, Spinal cord injury, Brachial plexopathy.
Poster 224 Obesity and Disability. Paolo Capodaglio, MD (Istituto Auxologico Italiano, IRCCS, Verbania, Italy); Marco Cavigioli; Francesco Menegoni; Luca Vismara. Disclosures: P. Capodaglio, None. Objective: Obesity is frequently associated with various musculoskeletal disorders including impairment of the spine and low back pain (LBP). Chronic musculoskeletal conditions impact on the subjects’ capacity to perform daily life activities eventually leading to disability. The role of obesity in the disablement process needs further scientific evidence. The aim of our study was to provide evidence of a direct correlation between body weight and disability. Setting: Hospital-based study. Participants: 77 obese patients (BMI 41 ⫾ 7 kg/m2, age 44 ⫾ 11 years) have been selected: 53 with non-specific low back pain (nsLBP), 12 with specific low back pain (sLBP) and 12 with no pain (NP). Main Outcome Measures: Pain was measured with the VAS (0-100) scale1. Disability was measured with the Roland and Morris Disability Questionnaire (Rm) 2 and the Oswestry Low Back Pain and Disability Questionnaire (O) 3. VAS, Rm and O were considered ordinal variables, thus we used non-parametric tests: Spearman rank order correlations (P⬍.05) for the correlations and Mann Whitney U-Test for comparison between groups. Results: The strongest correlation was found between body weight and disability, as measured by O, in sLBP patients (R ⫽ 0.74, P ⫽ .005). In nsLBP a significant but lower correlation (R ⫽ .35, P ⫽ .01) was found. A significant correlation (R ⫽ .24, P ⫽ .036) was evident when all LBP patients were considered, but no correlation was found in NP obese subjects. Conclusions: Body weight appears to have a fundamental role in the onset of LBP and a direct correlation with the disablement process. Keywords: Low back pain, Disability, Obesity.
Poster 225 Opsoclonus-Myoclonus Syndrome Associated with Hepatitis B Infection: A Case Report. David Ronin, (Lutheran General Hospital, Park Ridge, IL); Lloyd S. Davis, MD; Susan Lis, MD; Amy Sun, MD. Disclosures: D. Ronin, None. Patients or Programs: We describe a case of a 44-yearold man with no significant medical history who was admitted to an acute care hospital with sudden onset of dizziness, horizontal nystagmus and truncal ataxia.
Vol. 1, Iss. 9S, 2009
S201
Program Description: Extensive work-up for underlying malignancy, collagen vascular disease and infectious process was negative. Based on clinical presentation the patient was diagnosed with opsoclonus-myoclonus syndrome (OMS). Setting: Tertiary hospital based acute care rehabilitation unit. Results: Infectious work- up was negative for cytomegalovirus, Epstein-Barr virus or HIV. The patient was started on high-dose IV steroids. Subsequently he was transferred to the rehabilitation unit of the hospital. Liver function tests were done. There was slight increase in ALT, 99 units/L. Hepatitis screen was positive for hepatitis B infection. Hepatitis B DNA viral load was high at 7.6 (42,100,000 IU/mL). Normal level is less than 1.6. Patient’s functional status significantly improved. Entecavir was going to be used to treat hepatitis B infection as an outpatient. Discussion: OMS is a rare debilitating disorder affecting children and adults. Underlying cause may involve infections or occult malignancy. Etiology of symptoms in OMS syndrome is postulated to be immune-mediated response directed against a select group of neurons. Opsoclonus is associated with impairment of pause cells in pontine reticular formation. Ataxia, truncal and limb myoclonus are due to loss of cerebellar neurons. Identification of actual microorganism in OMS is extremely rare. Reported viral infections include cytomegalovirus and Epstein-Barr virus. This is the first case, to our knowledge, of OMS associated with hepatitis B virus. Conclusions: We conclude that hepatitis B virus should be included in differential diagnosis of OMS. Early treatment may significantly improve patient’s outcome. Keywords: Rehabilitation, Opsoclonus-myoclonus syndrome, Hepatitis B virus.
Poster 226 Ovarian Vein Thrombophlebitis (OVT), a Rare Cause of Persistent Fever in the Setting of Acute Inpatient Rehabilitation: A Case Report. Sangmin Ahn, MD (Baylor College of Medicine, Houston, TX); Pari Azari; John S. Harrell, MD. Disclosures: S. Ahn, None. Patients or Programs: A 30-year-old woman with left hemiparesis secondary to a right basal ganglia hematoma due to eclampsia, status post emergent cesarean section and right frontotemporal craniotomy with evacuation. Program Description: A 30-year-old woman at 38 week gestation presented with seizures secondary to eclampsia. Seizures were controlled with magnesium sulfate but the patient sustained a left basal ganglia intracerebral hemorrhage with resultant hemiparesis. Cesarean section followed by right frontotemporal craniotomy with evacuation was emergently performed. She was transferred to inpatient rehabilitation for functional deficits related the hemiparesis. Persistent fever with leukocytosis developed on admission with unremarkable review of systems except headache and sore-