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Poster 233 Normal Pressure Hydrocephalus Associated with Toxic Minocycline Findings: A Case Report
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Abstracts / PM R 8 (2016) S151-S332
Setting: Acute inpatient rehabilitation. Results: With physical, occupational, and speech therapy interventions, and physiatric care of secondary stroke prevention and PV the patient’s condition improved. Upon discharge he was modified independent with mobility and set up for supervision with activities of daily living. Discussion: PV is a myeloproliferative genetic disorder that exerts its effect through hyperviscosity of the blood inducing a hypercoagulable state. Symptoms of PV commonly include pruritis, and erythromelalgia. Ischemic infarct as a presenting symptom of PV is rare and treatment includes hemodilution and in severe cases phlebotomy. Reinfarction may occur in these patients and physiatrists treating these patients must have high index of suspicion in patients with PV in order to initiate treatment to prevent further cerebrovascular accidents. Conclusions: This case highlights a rare case of PV presenting as acute ischemic infarct. PV is a rare but potentially life threatening disorder, and therapy must be initiated immediately as reinfarction can occur in these patients. Level of Evidence: Level V Poster 232 Cerebral Palsy Adult Transition (CPAT) Cross-Sectional Study Preliminary Findings: Chronic Pain Correlates with Memory Difficulties in Adults with Cerebral Palsy Sruthi P. Thomas, MD, PhD (University of Colorado Anschutz Medical Campus, Denver, CO, United States), Zhaoxing Pan, PhD, David M. Robertson, BS, Allison Frickman, BA, James J. Carollo, PhD, PE, Patricia C. Heyn, PhD Disclosures: Sruthi Thomas: I Have No Relevant Financial Relationships To Disclose Objective: To examine the relationship between patient-reported perceptions of chronic pain among adults with cerebral palsy (CP) and to examine variables (including memory issues) associated with chronic pain. Design: Adult patients with CP (or their guardians) were asked to participate in a phone survey. A subset of the sample was invited to join a face-to-face comprehensive Cerebral Palsy Adult Transition (CPAT) Patient-Centered Outcome study. They were asked to respond to numerous health questionnaires, including specific questions regarding chronic pain and difficulties with memory. Setting: Patients were surveyed on the phone and at the Center for Gait and Movement Analysis at the Children’s Hospital of Colorado (CHCO). Participants: 92 ambulatory adult patients (18 years old) with any form of CP were asked to participate in a phone survey. All participants previously received medical care at CHCO, including quantitative gait analyses. Ages ranged from 18-59 years old (mean ¼ 257, median ¼ 22). Interventions: Not applicable. Main Outcome Measures: Chronic pain, health status. Results: Out of 92 patients screened, 32 reported chronic pain (35%). Individuals reporting chronic pain had a higher prevalence of memory difficulties (P ¼ .0016). Patients reporting chronic pain were older than those without (2810 years vs 234.7 years, P ¼ .002). There was no significant difference in the ages of individuals with or without memory difficulties (247.9 years vs 266.5 years, P ¼ .33). After adjusting for age and gender, those with chronic pain were more likely to report memory difficulties than those without chronic pain (58% vs 23%, P ¼ .003) based on logistic regression analysis. Conclusions: There is a correlation between chronic pain and memory difficulties in adult patients with CP. Further studies are needed to elucidate the connection between these two pathologies in the adult CP population. Level of Evidence: Level III
Poster 233 Normal Pressure Hydrocephalus Associated with Toxic Minocycline Findings: A Case Report Nicholas C. Kinback, MD (Temple University Hospital/Moss Rehab Hospital, Wilmore, PA, United States) Disclosures: Nicholas Kinback: I Have No Relevant Financial Relationships To Disclose Case/Program Description: The patient is a 57-year-old otherwise healthy man who presented after a fall at home striking his head without loss of consciousness. In the months prior to presentation he had progressive symptoms of gait dysfunction, urinary incontinence, and cognitive impairment. Initial neuroimaging found a small subdural hematoma from the fall and ventriculomegaly, later diagnosed by neurosurgery as NPH. Repeat imaging showed stable findings, so patient was admitted to acute inpatient rehab. On examination, the patient had findings of distinct blue skin discoloration of hands, lower legs, and nails. Further history revealed the patient was on chronic oral doses of minocycline for rosacea for several years, but had recently self-discontinued due to worsening skin changes. In addition, a previous shoulder arthroscopy found blue pigment deposited in bone, with biopsy negative for other pathology to explain the phenomenon. Setting: Acute inpatient rehabilitation hospital. Results: The patient completed inpatient rehab and was discharged home with family. He was later treated with successful ventriculoperitoneal shunting without complications. The patient experienced a near full neurologic recovery, passed a drivers test and returned to his daily activities. Discussion: The severity of the patient’s blue skin and bone discoloration suggests medication toxicity. Minocycline has known side effects of headaches and skin discoloration, but has also similarly been associated with pseudotumor cerebri and papilledema in case reports. Research has shown possible affects on cerebrospinal fluid and has been implicated as both a neurodegenerative and neuroprotective agent. Conclusions: This is the first case to our knowledge to demonstrate a possible association with toxic minocycline findings and NPH. More research is needed to elucidate the relationship of minocycline and neurologic conditions. Level of Evidence: Level V
Poster 234 Cocaine-Induced Spinal Cord Infarct in a Patient with Copper and Zinc Deficiencies: A Case Report Mark Bauernfeind, MD (University of Rochester, Rochester, NY, United States), Kristen M. Brusky, DO, Jean L. Nickels, MD Disclosures: Mark Bauernfeind: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 28-year-old malnourished male with a history of lead poisoning and cocaine and marijuana abuse presented with acute-onset numbness from the mid-chest down, quadriplegia, and urinary retention. Examination revealed impaired sensation below C4, bilateral distal greater than proximal arm weakness, bilateral leg plegia, and intact rectal tone. Urine toxicology was positive for cocaine and cannabinoids. Spinal cord magnetic resonance imaging demonstrated C3 to T1-2 anterior spinal cord infarction, attributed to cocaine-induced vasculitis. Additional work-up revealed severe copper and zinc deficiencies. Setting: An inpatient rehabilitation unit at a tertiary care hospital. Results: Following an intensive care unit stay, the patient was admitted to acute rehabilitation. Prolonged steroid treatment for vasculitis and aggressive copper repletion was continued. He regained some upper extremity strength and function, progressing from maximum to set up assistance with upper extremity self-care. Lower
Abstracts / PM R 8 (2016) S151-S332
Setting: Acute inpatient rehabilitation. Results: With physical, occupational, and speech therapy interventions, and physiatric care of secondary stroke prevention and PV the patient’s condition improved. Upon discharge he was modified independent with mobility and set up for supervision with activities of daily living. Discussion: PV is a myeloproliferative genetic disorder that exerts its effect through hyperviscosity of the blood inducing a hypercoagulable state. Symptoms of PV commonly include pruritis, and erythromelalgia. Ischemic infarct as a presenting symptom of PV is rare and treatment includes hemodilution and in severe cases phlebotomy. Reinfarction may occur in these patients and physiatrists treating these patients must have high index of suspicion in patients with PV in order to initiate treatment to prevent further cerebrovascular accidents. Conclusions: This case highlights a rare case of PV presenting as acute ischemic infarct. PV is a rare but potentially life threatening disorder, and therapy must be initiated immediately as reinfarction can occur in these patients. Level of Evidence: Level V Poster 232 Cerebral Palsy Adult Transition (CPAT) Cross-Sectional Study Preliminary Findings: Chronic Pain Correlates with Memory Difficulties in Adults with Cerebral Palsy Sruthi P. Thomas, MD, PhD (University of Colorado Anschutz Medical Campus, Denver, CO, United States), Zhaoxing Pan, PhD, David M. Robertson, BS, Allison Frickman, BA, James J. Carollo, PhD, PE, Patricia C. Heyn, PhD Disclosures: Sruthi Thomas: I Have No Relevant Financial Relationships To Disclose Objective: To examine the relationship between patient-reported perceptions of chronic pain among adults with cerebral palsy (CP) and to examine variables (including memory issues) associated with chronic pain. Design: Adult patients with CP (or their guardians) were asked to participate in a phone survey. A subset of the sample was invited to join a face-to-face comprehensive Cerebral Palsy Adult Transition (CPAT) Patient-Centered Outcome study. They were asked to respond to numerous health questionnaires, including specific questions regarding chronic pain and difficulties with memory. Setting: Patients were surveyed on the phone and at the Center for Gait and Movement Analysis at the Children’s Hospital of Colorado (CHCO). Participants: 92 ambulatory adult patients (18 years old) with any form of CP were asked to participate in a phone survey. All participants previously received medical care at CHCO, including quantitative gait analyses. Ages ranged from 18-59 years old (mean ¼ 257, median ¼ 22). Interventions: Not applicable. Main Outcome Measures: Chronic pain, health status. Results: Out of 92 patients screened, 32 reported chronic pain (35%). Individuals reporting chronic pain had a higher prevalence of memory difficulties (P ¼ .0016). Patients reporting chronic pain were older than those without (2810 years vs 234.7 years, P ¼ .002). There was no significant difference in the ages of individuals with or without memory difficulties (247.9 years vs 266.5 years, P ¼ .33). After adjusting for age and gender, those with chronic pain were more likely to report memory difficulties than those without chronic pain (58% vs 23%, P ¼ .003) based on logistic regression analysis. Conclusions: There is a correlation between chronic pain and memory difficulties in adult patients with CP. Further studies are needed to elucidate the connection between these two pathologies in the adult CP population. Level of Evidence: Level III
Poster 233 Normal Pressure Hydrocephalus Associated with Toxic Minocycline Findings: A Case Report Nicholas C. Kinback, MD (Temple University Hospital/Moss Rehab Hospital, Wilmore, PA, United States) Disclosures: Nicholas Kinback: I Have No Relevant Financial Relationships To Disclose Case/Program Description: The patient is a 57-year-old otherwise healthy man who presented after a fall at home striking his head without loss of consciousness. In the months prior to presentation he had progressive symptoms of gait dysfunction, urinary incontinence, and cognitive impairment. Initial neuroimaging found a small subdural hematoma from the fall and ventriculomegaly, later diagnosed by neurosurgery as NPH. Repeat imaging showed stable findings, so patient was admitted to acute inpatient rehab. On examination, the patient had findings of distinct blue skin discoloration of hands, lower legs, and nails. Further history revealed the patient was on chronic oral doses of minocycline for rosacea for several years, but had recently self-discontinued due to worsening skin changes. In addition, a previous shoulder arthroscopy found blue pigment deposited in bone, with biopsy negative for other pathology to explain the phenomenon. Setting: Acute inpatient rehabilitation hospital. Results: The patient completed inpatient rehab and was discharged home with family. He was later treated with successful ventriculoperitoneal shunting without complications. The patient experienced a near full neurologic recovery, passed a drivers test and returned to his daily activities. Discussion: The severity of the patient’s blue skin and bone discoloration suggests medication toxicity. Minocycline has known side effects of headaches and skin discoloration, but has also similarly been associated with pseudotumor cerebri and papilledema in case reports. Research has shown possible affects on cerebrospinal fluid and has been implicated as both a neurodegenerative and neuroprotective agent. Conclusions: This is the first case to our knowledge to demonstrate a possible association with toxic minocycline findings and NPH. More research is needed to elucidate the relationship of minocycline and neurologic conditions. Level of Evidence: Level V
Poster 234 Cocaine-Induced Spinal Cord Infarct in a Patient with Copper and Zinc Deficiencies: A Case Report Mark Bauernfeind, MD (University of Rochester, Rochester, NY, United States), Kristen M. Brusky, DO, Jean L. Nickels, MD Disclosures: Mark Bauernfeind: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 28-year-old malnourished male with a history of lead poisoning and cocaine and marijuana abuse presented with acute-onset numbness from the mid-chest down, quadriplegia, and urinary retention. Examination revealed impaired sensation below C4, bilateral distal greater than proximal arm weakness, bilateral leg plegia, and intact rectal tone. Urine toxicology was positive for cocaine and cannabinoids. Spinal cord magnetic resonance imaging demonstrated C3 to T1-2 anterior spinal cord infarction, attributed to cocaine-induced vasculitis. Additional work-up revealed severe copper and zinc deficiencies. Setting: An inpatient rehabilitation unit at a tertiary care hospital. Results: Following an intensive care unit stay, the patient was admitted to acute rehabilitation. Prolonged steroid treatment for vasculitis and aggressive copper repletion was continued. He regained some upper extremity strength and function, progressing from maximum to set up assistance with upper extremity self-care. Lower