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Poster 327: Acute Paralysis as the Initial Manifestation of Systemic Lupus Erythematosus: A Case Report
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preventing spinal cord damage will be discussed including the current standard of care for best-practice surgical techniques on insertion level, thecal sac penetration level and catheter tip position. Conclusions: Although rare, spinal cord transection is a potential side effect of intrathecal baclofen pump placement. Keywords: Rehabilitation, Foot drop, Intrathecal baclofen pump, Spinal cord transection.
Poster 326 Acute Exacerbation of Chronic Spinal Stenosis by Free Disk Material in Spinal Canal: A Case Report. Carley N. Sauter, MD (Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI); Thomas Kotsonis, MD. Disclosures: C. N. Sauter, None. Patients or Programs: A 75-year-old man with known spinal stenosis and severe lumbar degenerative disk disease with stable symptoms over many years Setting: Tertiary care Veteran’s Hospital. Results: The patient was being treated on an acute rehabilitation unit following an elective total knee arthroplasty and was discharged home at a modified independent level with full lower extremity strength, on Lovenox for deep vein thrombosis prophylaxis. During the 5 days following discharge, he had acute worsening of lumbar pain of a different quality and location than his chronic pain and increased lower extremity weakness. He was readmitted with for evaluation and treatment. MRI revealed an L1-L2 abnormal anterior epidural subligamentous collection with heterogenous signal exerting significant mass effect upon the spinal canal with severe stenosis of the thecal sac, felt to be consistent with hematoma. CT confirmed the presence of a large, partially calcified abnormality. The patient underwent laminectomy and fusion, and operative findings revealed that the mass was composed of extruded disk material that had migrated cephalad. Assessment: Postoperatively, the patient regained lower extremity strength and continued to make functional progress. He was discharged home at the modified independent level for ambulation, transfers, activities of daily living, and stairs. Discussion: Free disk material may migrate and be large enough to cause acute exacerbation of chronic lumbar stenosis, severe enough to require decompression. We discuss the etiology, frequency, differential diagnosis and management of this relatively unusual event. Conclusions: This case is important as it illustrates how a chronic, stable case of lumbar stenosis may acutely worsen due to migration of extruded disk material. It is important for physiatrists to be aware of the multiple causes of acute spinal compression and recognize that imaging findings may be confused with an epidural hematoma.
POSTER PRESENTATIONS
Keywords: Rehabilitation, Spinal stenosis, Intervertebral disk displacement.
Poster 327 Acute Paralysis as the Initial Manifestation of Systemic Lupus Erythematosus: A Case Report. Jasmine Martinez-Barrizonte, DO (University of Miami/Jackson Memorial Hospital, Miami, FL); Kresimir Banovac, MD; Alberto Martinez-Arizala, MD. Disclosures: J. Martinez-Barrizonte, None. Patients or Programs: A 33-year-old man admitted to a Veterans Hospital for rehabilitation and treatment of sacral decubitus following acute transverse myelitis with presentation of T8 complete paraplegia diagnosed in July 2005. Etiology of acute paralysis was unknown at time and full workup up until admission had been negative. Retrospective review of the subject’s hospital records including diagnostic imaging from outside and the Veterans Hospital was completed. Findings from hospital chart review were compiled and a literature search using PubMed, Medline and Ovid were performed. Program Description: To report a case of acute paralysis presenting as the initial manifestation of SLE. Setting: Acute spinal cord injury rehabilitation center in a Veteran’s Hospital. Results: Retrospective analysis of the subject’s hospital course revealed evidence of clinical symptoms beginning with alopecia, photosensitivity, generalized rash and persistent fever uncorrelated to infectious etiology. Laboratory data revealed pancytopenia and elevated liver function tests warranting further evaluation. This resulted in further laboratory analysis for evaluation of an autoimmune etiology. The subject was found to have a serological profile including antidouble stranded DNA antibodies suggestive of neuropsychiatric systemic lupus erythematosus as the underlying cause of transverse myelitis. The subject received treatment with steroids and plaquenil for lupus exacerbation; however he did not have any return of function. Discussion: Acute paralysis from transverse myelitis is a rare complication in patients with SLE and may present as the first clinical manifestation of the disease in some patients. The literature is very sparse, comprised mostly of case reports due to the rarity of this presentation. The literature available has shown that a high proportion of affected subjects have variable degree of disability after treatment. Conclusions: Presentation of acute non-traumatic paralysis may be the first clinical manifestations present in a subject as a first process in SLE. If such autoimmune etiology may be the cause of paralysis and is identified early intervention then treatment implemented as soon as possible would be helpful to hopefully improve outcome of recovery. Keywords: Rehabilitation, Transverse myelitis, Spinal cord injury, Systemic lupus.
preventing spinal cord damage will be discussed including the current standard of care for best-practice surgical techniques on insertion level, thecal sac penetration level and catheter tip position. Conclusions: Although rare, spinal cord transection is a potential side effect of intrathecal baclofen pump placement. Keywords: Rehabilitation, Foot drop, Intrathecal baclofen pump, Spinal cord transection.
Poster 326 Acute Exacerbation of Chronic Spinal Stenosis by Free Disk Material in Spinal Canal: A Case Report. Carley N. Sauter, MD (Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI); Thomas Kotsonis, MD. Disclosures: C. N. Sauter, None. Patients or Programs: A 75-year-old man with known spinal stenosis and severe lumbar degenerative disk disease with stable symptoms over many years Setting: Tertiary care Veteran’s Hospital. Results: The patient was being treated on an acute rehabilitation unit following an elective total knee arthroplasty and was discharged home at a modified independent level with full lower extremity strength, on Lovenox for deep vein thrombosis prophylaxis. During the 5 days following discharge, he had acute worsening of lumbar pain of a different quality and location than his chronic pain and increased lower extremity weakness. He was readmitted with for evaluation and treatment. MRI revealed an L1-L2 abnormal anterior epidural subligamentous collection with heterogenous signal exerting significant mass effect upon the spinal canal with severe stenosis of the thecal sac, felt to be consistent with hematoma. CT confirmed the presence of a large, partially calcified abnormality. The patient underwent laminectomy and fusion, and operative findings revealed that the mass was composed of extruded disk material that had migrated cephalad. Assessment: Postoperatively, the patient regained lower extremity strength and continued to make functional progress. He was discharged home at the modified independent level for ambulation, transfers, activities of daily living, and stairs. Discussion: Free disk material may migrate and be large enough to cause acute exacerbation of chronic lumbar stenosis, severe enough to require decompression. We discuss the etiology, frequency, differential diagnosis and management of this relatively unusual event. Conclusions: This case is important as it illustrates how a chronic, stable case of lumbar stenosis may acutely worsen due to migration of extruded disk material. It is important for physiatrists to be aware of the multiple causes of acute spinal compression and recognize that imaging findings may be confused with an epidural hematoma.
POSTER PRESENTATIONS
Keywords: Rehabilitation, Spinal stenosis, Intervertebral disk displacement.
Poster 327 Acute Paralysis as the Initial Manifestation of Systemic Lupus Erythematosus: A Case Report. Jasmine Martinez-Barrizonte, DO (University of Miami/Jackson Memorial Hospital, Miami, FL); Kresimir Banovac, MD; Alberto Martinez-Arizala, MD. Disclosures: J. Martinez-Barrizonte, None. Patients or Programs: A 33-year-old man admitted to a Veterans Hospital for rehabilitation and treatment of sacral decubitus following acute transverse myelitis with presentation of T8 complete paraplegia diagnosed in July 2005. Etiology of acute paralysis was unknown at time and full workup up until admission had been negative. Retrospective review of the subject’s hospital records including diagnostic imaging from outside and the Veterans Hospital was completed. Findings from hospital chart review were compiled and a literature search using PubMed, Medline and Ovid were performed. Program Description: To report a case of acute paralysis presenting as the initial manifestation of SLE. Setting: Acute spinal cord injury rehabilitation center in a Veteran’s Hospital. Results: Retrospective analysis of the subject’s hospital course revealed evidence of clinical symptoms beginning with alopecia, photosensitivity, generalized rash and persistent fever uncorrelated to infectious etiology. Laboratory data revealed pancytopenia and elevated liver function tests warranting further evaluation. This resulted in further laboratory analysis for evaluation of an autoimmune etiology. The subject was found to have a serological profile including antidouble stranded DNA antibodies suggestive of neuropsychiatric systemic lupus erythematosus as the underlying cause of transverse myelitis. The subject received treatment with steroids and plaquenil for lupus exacerbation; however he did not have any return of function. Discussion: Acute paralysis from transverse myelitis is a rare complication in patients with SLE and may present as the first clinical manifestation of the disease in some patients. The literature is very sparse, comprised mostly of case reports due to the rarity of this presentation. The literature available has shown that a high proportion of affected subjects have variable degree of disability after treatment. Conclusions: Presentation of acute non-traumatic paralysis may be the first clinical manifestations present in a subject as a first process in SLE. If such autoimmune etiology may be the cause of paralysis and is identified early intervention then treatment implemented as soon as possible would be helpful to hopefully improve outcome of recovery. Keywords: Rehabilitation, Transverse myelitis, Spinal cord injury, Systemic lupus.