Poster 239 Cervical cord neuropraxia after trauma: a case report Serge Menkin MD (Temple Univ Hosp, Philadelphia, PA); Ian B. Maitin MD, [email protected]

2004 Academy Annual Assembly Abstracts very little compliance to the compressive effects of epidural fat. This may explain the conversion from relatively asymptomatic to symptomatic spinal epidural lipomatosis in this patient. Conclusions: A therapeutic regimen that involves rehabilitation, pain medication, and a discontinuation of corticosteroid therapy (if applicable) is an appropriate first-line treatment for symptomatic spinal epidural lipomatosis. Key Words: Corticosteroids; Lipomatosis; Obesity; Rehabilitation. Poster 238 Functional and Neurologic Recovery After Cervical Epidural Abscess. Dolly Devara, MD (Marianjoy Rehabil Hosp, Wheaton, IL); Vasilios Stambolis, MD, e-mail: sbrady@ marianjoy.org. Disclosure: D. Devara, None; V. Stambolis, None. Setting: Freestanding rehabilitation hospital. Patients: 5 consecutive patients (3 men, 2 women; mean age, 56.2y) were admitted over a 12-mo period with the diagnosis of a cervical epidural abscess. Case Descriptions: All had mid- to lower-level cervical epidural abscesses with identifiable source of seeding. They were appropriately treated with surgical decompression and intravenous antibiotics in acute care hospitals. At admission to the rehabilitation hospital, all 5 patients had incomplete quadriplegia with dysphagia and neurogenic bowel and bladder. 3 had tracheostomies and gastrostomy tubes (G-tubes) at admission. Assessment/Results: Steady neurologic and functional improvements were seen in all the patients. Successful weaning off the tracheostomies and G-tubes was performed and bowel and bladder retraining was successful in the most part. Assistive devices and custom orthoses were provided. Videofluoroscopic swallow studies and cystometrograms were performed as follow-up. Pool therapy was initiated for 1 patient with C4 ASIA grade B quadriplegia. Results: Patients’ mean admission FIM score ⫾ SD was 32.40⫾8.562 and their mean discharge FIM score was 66.20⫾17.079. The difference between the mean admission and discharge FIM scores was statistically significant (P⫽.015). Motor strength improved by 1 to 3 grades in all the muscles below the neurologic level of injury. The average length of stay was 67.80⫾17.283d. Independence was achieved in eating and grooming in all patients except 1, who was given a left balanced forearm orthosis. By discharge, all 5 patients were ambulating with stand-by to modified independence using an assistive device. Discussion: Cervical epidural abscess, though once rare, has been seen increasingly in the last decade. Prompt diagnoses with surgical decompression and/or conservative management yield good neurologic outcomes for this sometimes irreversible and fatal disease. Conclusions: Significant functional and neurologic outcomes are seen in patients with cervical epidural abscess during inpatient rehabilitation. Key Words: Epidural abscess; Recovery of function; Rehabilitation. Poster 239 Cervical Cord Neuropraxia After Trauma: A Case Report. Serge Menkin, MD (Temple Univ Hosp, Philadelphia, PA); Ian B. Maitin, MD, e-mail: [email protected]. Disclosure: S. Menkin, None; I.B. Maitin, None. Setting: Tertiary care hospital. Patient: A 35-yo man previously in good health with a medical history of C4-5 spinous processes fracture. Case Description: The patient presented to the hospital with new bilateral upper- and lower-extremity burning pain, numbness, and weakness after an assault. He was kicked on the chin and fell backward. Computed tomography of the spine showed no acute fracture, wired spinous processes at C2-5, fused C4-5, C4-5 osteophytes, and degenerative facet changes at C7-T1. On physical examination, he had mildly decreased strength in all 4 extremities and significantly decreased sensation to light touch, pinprick, and vibration from C2 dermatome and down. He also had hyperreflexia in both upper and lower extremities, bilateral Hoffman’s sign, and 2 to 3 beats of clonus in lower extremities. Assessment/Results: This patient’s presentation was consistent with cervical cord neuropraxia. The patient’s symptoms slowly improved over a period of 6d, at which point he was able to ambulate with a walker. Discussion: Cervical cord neuropraxia involves an acute onset of transient neurologic symptoms originating in the cervical cord without structural deficiency and absence of instability. It has been commonly reported in young athletes and adults with cervical spinal stenosis. The usual duration of the symptoms is between 15min and 48h. Conclusions: In this case, symptoms persisted over 6d. In addition, previous neck surgery has not been reported as a predisposing factor for cervical cord neuropraxia. Key Words: Quadriparesis; Rehabilitation; Spinal stenosis.

Poster 240 Spinal Ataxia from Ewing’s Sarcoma: A Case Report. Yusuf Z. Tatli III, MD (New York Presbyterian The University Hospitals of Columbia and Cornell, New York, NY); Michael D. Stubblefield, MD; Christian M. Custodio, MD, e-mail: [email protected]. Disclosure: Y.Z. Tatli, None; M.D. Stubblefield, None; C.M. Custodio, None. Setting: Tertiary care cancer hospital. Patient: A patient with paraplegia from Ewing’s sarcoma. Case Description: A 31-yo man presented with acute onset paraplegia. He underwent surgical debulking, decompression, and fixation from T2 to T6 for tumor and spinal cord compression. The tissue diagnosis of Ewing’s sarcoma was made. He was admitted for a short course of acute rehabilitation followed by transfer to a tertiary care cancer hospital for initiation of definitive chemotherapy. Signs and symptoms on initial presentation were weakness, lower-extremity pain, lower-extremity numbness, and inability to ambulate. When evaluated ⯝1mo later, physical examination revealed near normal strength and sensation to pinprick and light touch. Slight weakness of ankle dorsi- and plantarflexion (4/5) and decreased lower-extremity proprioception were noted. Reflexes were minimally brisk in the lower extremities compare with the upper. He was continent of bowel and bladder. Despite a T4 (by historical sensory level) ASIA grade D classification, his gait was severely impaired due to marked truncal and lower-extremity ataxia. Assessment/Results: T4 ASIA grade D paraplegia with marked gait abnormality due to spinal ataxia. The predominantly posterior column involvement from tumor compression, ischemia, and/or infarct was thought to be the most likely etiology of the spinal ataxia and gait abnormality. Discussion: In this case of T4 ASIA grade D paraplegia, the predominantly posterior column findings, including decreased proprioception and spinal ataxia, were thought to be the greatest impairments to ambulation. Anterior column functions, including strength, light touch, and pinprick, were relatively preserved. The functional prognosis for spinal ataxia due to posterior column involvement is

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unclear. Conclusions: Predominantly posterior column involvement from spinal cord injuries can cause profound functional deficits without a significant loss of strength. The ASIA classification does not take proprioceptive deficits into account. Key Words: Ataxia; Neoplasms; Rehabilitation; Spinal cord injuries. Poster 241 Incomplete Paralysis as a Presentation of Neurosarcoidosis: A Case Report. Jill A. Marple, MD (Thomas Jefferson Univ Hosp, Philadelphia, PA); Lynn Yang, MD, e-mail: marps97@ yahoo.com. Disclosure: J.A. Marple, None; L. Yang, None. Setting: Tertiary care hospital. Patient: 26-yo healthy African-American man. Case Description: The patient presented to the emergency department with right-sided numbness and paralysis of his legs. He had a 2-wk history of progressive neck and back pain, tingling in his right leg, and intact bowel and bladder function. He also had weight loss, night sweats, fever, and a recent urinary tract infection. On examination, he had decreased sensation below T4, 0/5 strength in the lower limbs, and sustained clonus. A chest radiograph revealed bilateral hilar adenopathy. Magnetic resonance imaging revealed inflammation of the spinal cord from T4 through T7. Mediastinal biopsy revealed a nonnecrotizing granuloma, consistent with sarcoidosis. Corticosteroid treatment was initiated. Assessment/Results: The patient exhibited significant clinical improvement within 36h of steroid treatment, with return of normal strength in the left leg and 2/5 strength in the right. He was discharged with axillary crutches and continued steroid treatment. Prolonged use of steroids led to significant remission of the pulmonary and spinal sarcoid; however, he also developed avascular necrosis in both hips and shoulders. He subsequently required multiple joint replacements and a right molded ankle-foot orthosis. Discussion: The incidence of neurosarcoidosis is only 5% to 10% of all sarcoid patients. Among those, only 1% involve the spinal cord. Most of these patients have a known history of pulmonary sarcoidosis before the manifestation of neurologic symptoms. This patient made a significant recovery with the treatment of corticosteroids and aggressive therapy. Conclusions: Sarcoidosis should be considered with a subacute presentation of neurologic deficits in a previously healthy patient, because proper diagnosis can expedite proper treatment and preserve function. However, prolonged therapy with corticosteroids may present new comorbidities as a result of their systemic side effects. Key Words: Rehabilitation; Sarcoidosis; Spinal cord injuries. Poster 242 The Effect of Penile Vibratory Stimulation on Spasticity in Persons With Spinal Cord Injury. Ahmet S. Goktepe, MD (Gulhane Mili Med Acad Rehabil Ctr, Ankara, Turkey); Necmettin Yildiz; Bilge Yilmaz; Ridvan Alaca; Sukru Gunduz, e-mail: [email protected]. Disclosure: A.S. Goktepe, None; N. Yildiz, None; B. Yilmaz, None; R. Alaca, None; S. Gunduz, None. Objective: To determine the effect of penile vibratory stimulation on lower-extremity spasticity in patients with spinal cord injury (SCI). Design: Single group, prospective study. Setting: SCI unit of a rehabilitation center. Participants: 10 men with SCI with Ashworth Scale grade 1 through 4 spasticity and who were at least 1y postinjury. Intervention: After their baseline examination, patients performed penile vibratory stimulation. Main Outcome Measures: Spasticity (Ashworth Scale), spasm frequency, spasm severity, painful spasms, plantar stimulation response, deep tendon reflexes, clonus, and effect on function were evaluated at the baseline and then 3, 6, 24, and 48h later. Results: Spasticity (Ashworth) showed a statistically significant decrease at the 3- and 6-h examinations (Tukey test, P⫽.001, P⫽.03, respectively). The patients showed a tendency toward having less frequent and less severe spasms throughout the study, however, the trend was not statistically significant. Similarly, clonus showed a nonsignificant decrease during follow-up examinations. The other parameters did not change considerably. Conclusions: Penile vibratory stimulation may contribute to the relief of the spasticity in men with SCI. Spasticity treatment should consider all the factors that may increase or decrease the tone. Key Words: Muscle spasticity; Penis; Rehabilitation; Spinal cord injuries; Vibration.

Poster 243 Assessment of the Descending Autonomic Pathways in Men With Spinal Cord Injury Undergoing Vibrostimulation for Sperm Retrieval. Andrei Krassioukov, MD, PhD (Univ British Columbia, Vancouver, BC, Canada); Bill Sheel, PhD; Timothy Inglis, PhD; Stacy Elliott, BA, MD, e-mail: [email protected]. Disclosure: A. Krassioukov, grant from the British Columbia Neurotrauma Foundation; grant from the Rick Hansen Foundation; B. Sheel, grant from the British Columbia Neurotrauma Foundation; grant from the Rick Hansen Foundation; T. Inglis, grant from the British Columbia Neurotrauma Foundation; grant from the Rick Hansen Foundation; S. Elliott, grant from the British Columbia Neurotrauma Foundation; grant from the Rick Hansen Foundation. Objectives: To examine the preservation of the spinal autonomic pathways in people with spinal cord injury (SCI). Design: Prospective clinical study of men with SCI undergoing sperm retrieval. Settings: University-based tertiary urban rehabilitation center and hospital-based sperm retrieval clinic. Participants: 7 male volunteers with SCI. Intervention: Vibrostimulation for sperm retrieval; electrophysiologic assessment of the spinal autonomic pathway sympathetic skin responses (SSRs). Main Outcome Measures: Systolic and diastolic blood pressure, heart rate, motor and sensory assessment, and ASIA grade. Results: Numerous studies suggest that the severity of injury, evaluated by ASIA score, correlates with the severity cardiovascular dysfunctions after SCI. To date, the association between abnormal cardiovascular control and the severity of injury of spinal autonomic pathways has not been examined. 2 groups of subjects with complete (ASIA grade A, n⫽4) and incomplete (ASIA grades B–C, n⫽3) cervical SCI undergoing sperm-retrieval by vibrostimulation were included in the study. Changes in arterial blood pressure and heart rate during the ejaculation and presence of SSRs were examined to establish an association between abnormal cardiovascular control and severity of destruction within the spinal autonomic pathways. Autonomic dysreflexia (paradoxical increase in arterial blood pressure to the peripheral stimuli) was observed in both groups, suggesting a severe injury to the spinal autonomic pathways. Total destruction of the spinal autonomic pathways in subjects with incomplete SCI was confirmed electrophysiologically

Arch Phys Med Rehabil Vol 85, September 2004