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Poster 33 Unique Presentation of Terson's Syndrome in a Traumatic Brain Injury Patient: A Case Report
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pressive craniectomy should be aware of the clinical features and surgical management of ST. Early cranioplasty should be considered in the rehab setting in patients with acute decompensation as well as functional plateauing. Poster 33 Unique Presentation of Terson’s Syndrome in a Traumatic Brain Injury Patient: A Case Report. James W. Bailey, DO (Temple University Hospital, Philadelphia, PA, United States); Sooja Cho, MD; David M. Mahon, DO. Disclosures: J. W. Bailey, Employment: Temple University Hospital. Case Description: A 30-year-old man sustained a right frontal lobe contusion, subdural hematoma, and subarachnoid hemorrhage following a high-speed motorcycle collision. He was initially comatose and required a decompressive craniectomy for elevated intracranial pressure. After regaining consciousness during his acute hospital course, no visual deficits were identified. Neuroimaging studies revealed no evidence of ocular abnormalities. On admission to our inpatient rehabilitation unit 2 weeks post-injury, baseline visual field testing uncovered binasal hemianopsia. Due to the extremely rare incidence of this pattern and our concerns about the specific anatomic aberrations often required for its manifestation, ophthalmology was consulted immediately. Fundoscopic examination revealed bilateral vitreous hemorrhage. Setting: Tertiary care hospital and rehabilitation facility. Results or Clinical Course: Further evaluation by a retina specialist confirmed the diagnosis of Terson’s syndrome. Given the extent of hemorrhage and the low likelihood of spontaneous resorption, the patient first underwent early left vitrectomy at 5 weeks post-injury. After discharge from our facility, a right vitrectomy was performed. At outpatient physiatry follow-up 4 months post-injury, the patient was noted to have full recovery of vision in both eyes. Discussion: Terson’s syndrome was originally defined by the occurrence of vitreous hemorrhage in association with subarachnoid hemorrhage, but now encompasses any intraocular hemorrhage associated with intracranial hemorrhage and elevated intracranial pressure. Typically, patients present with global vision loss of varying degrees. This is the first reported case, to our knowledge, of binasal hemianopsia associated with Terson’s syndrome. Conclusions: A thorough baseline neurologic examination for patients with traumatic brain injury is necessary to identify deficits such as vision loss. Early recognition and treatment of Terson’s syndrome in this unique case prevented permanent visual impairment and allowed for maximum functional recovery with improved quality of life. Poster 34 Patterns of Anti-Epileptic Drug Use in Acute Rehabilitation. Jennifer M. Zumsteg, MD (University of Washington, Seattle, WA, United States); Kathleen R. Bell, MD; Christian Shenouda, MD. Disclosures: J. M. Zumsteg, No Disclosures. Objective: To compare the frequency and type of anti-epileptic drugs (AED) used during inpatient rehabilitation for acquired brain injury (ABI) between the years 1998 and 2008. Design: Retrospective chart review. Setting: University-based hospital inpatient rehabilitation unit.
Vol. 4, Iss. 10S, 2012
S201
Participants: 85 patients admitted to inpatient rehabilitation during calendar years 1998 and 2008 with ABI. Interventions: Not applicable. Main Outcome Measures: Demographics, AEDs upon admission and discharge. Results: In 1998 and 2008 patients admitted with ABI numbered 15 and 70, respectively. Brain injury diagnoses: brain neoplasm (43%), toxic/anoxic encephalopathy (17.44%), subarachnoid hemorrhage (16.28%), stroke (9.3%), traumatic brain injury (5.81%) and other (19.76%). On admission in 1998, four of 16 subjects had no AEDs, eight (50%) were taking phenytoin, and 6 were taking at least one other AED. Of the 70 admissions in 2008, 25 had no AEDs (35.71%), 26 were prescribed levetiracetam (37.14%), 12 were taking phenytoin (17.14%) and 12 subjects were taking other AEDs. Conclusions: Initial descriptive analysis of AED prescription frequency in ABI indicates that AEDs are commonly prescribed medications. While phenytoin was a common agent prescribed in 2008, the newer AED levetiracetam was prescribed more than twice as often. This study suggests the importance of understanding the efficacy and side effects of newer AEDs in those with ABI. A second study site will include additional data for ⬎300 subjects, allowing for more robust analysis between 1998 and 2008 data, including secondary analyses based on seizure characteristics and diagnosis. Poster 35 Association of Acute Neuroimaging Abnormalities and Headache in the First Year After Traumatic Brain Injury. Kathleen Bell, MD (University of Washington, Seattle, WA, United States); Jennifer Devine, MD; Sureyya Dikmen, PhD; Jeanne M. Hoffman, PhD; Sylvia Lucas, MD, PhD. Disclosures: K. Bell, Research grants: NIDRR, H133A070032. Objective: Examine the frequency of acute neuroimaging abnormalities and their association with headache severity and persistence in the first year after traumatic brain injury (TBI). Design: Prospective observational study. Setting: Inpatient rehabilitation (IR) and post discharge. Participants: 452 consecutive patients with TBI admitted to 7 TBI Model Systems IR units between February 2008 and June 2009. Interventions: Not applicable. Main Outcome Measures: Structured interview on headache status collected at IR, 3, 6 and 12 months post TBI. Acute injury head computed tomography (CT) was inventoried for 10 abnormalities: focal cortical/parenchymal contusion, focal non-cortical contusion, intraventricular hemorrhage (IVH), subarachnoid hemorrhage, skull, facial, or spine fracture, presence of extra-axial hematoma/hygroma (fluid), cistern compression/midline shift ⬎5mm, presence of imaging abnormalities at time of injury, early headache severity, and persistent headache (headaches at 3, 6 and 12 months post-TBI). Results: IVH was the most frequent abnormality (70%) noted on CT scans followed by focal contusions and presence of extra-axial fluid (both 60%). While skull fracture was less frequent (N⫽175), 41% with skull fracture reported moderate to severe headache during IR. Those who had mid-line shift (38%) and/or extra-axial fluid (34%) also reported higher rates of moderate to severe headache at IR. Complete headache information at all 3 time points was available for 273 of the 452 subjects and 63 (30%) of those subjects
pressive craniectomy should be aware of the clinical features and surgical management of ST. Early cranioplasty should be considered in the rehab setting in patients with acute decompensation as well as functional plateauing. Poster 33 Unique Presentation of Terson’s Syndrome in a Traumatic Brain Injury Patient: A Case Report. James W. Bailey, DO (Temple University Hospital, Philadelphia, PA, United States); Sooja Cho, MD; David M. Mahon, DO. Disclosures: J. W. Bailey, Employment: Temple University Hospital. Case Description: A 30-year-old man sustained a right frontal lobe contusion, subdural hematoma, and subarachnoid hemorrhage following a high-speed motorcycle collision. He was initially comatose and required a decompressive craniectomy for elevated intracranial pressure. After regaining consciousness during his acute hospital course, no visual deficits were identified. Neuroimaging studies revealed no evidence of ocular abnormalities. On admission to our inpatient rehabilitation unit 2 weeks post-injury, baseline visual field testing uncovered binasal hemianopsia. Due to the extremely rare incidence of this pattern and our concerns about the specific anatomic aberrations often required for its manifestation, ophthalmology was consulted immediately. Fundoscopic examination revealed bilateral vitreous hemorrhage. Setting: Tertiary care hospital and rehabilitation facility. Results or Clinical Course: Further evaluation by a retina specialist confirmed the diagnosis of Terson’s syndrome. Given the extent of hemorrhage and the low likelihood of spontaneous resorption, the patient first underwent early left vitrectomy at 5 weeks post-injury. After discharge from our facility, a right vitrectomy was performed. At outpatient physiatry follow-up 4 months post-injury, the patient was noted to have full recovery of vision in both eyes. Discussion: Terson’s syndrome was originally defined by the occurrence of vitreous hemorrhage in association with subarachnoid hemorrhage, but now encompasses any intraocular hemorrhage associated with intracranial hemorrhage and elevated intracranial pressure. Typically, patients present with global vision loss of varying degrees. This is the first reported case, to our knowledge, of binasal hemianopsia associated with Terson’s syndrome. Conclusions: A thorough baseline neurologic examination for patients with traumatic brain injury is necessary to identify deficits such as vision loss. Early recognition and treatment of Terson’s syndrome in this unique case prevented permanent visual impairment and allowed for maximum functional recovery with improved quality of life. Poster 34 Patterns of Anti-Epileptic Drug Use in Acute Rehabilitation. Jennifer M. Zumsteg, MD (University of Washington, Seattle, WA, United States); Kathleen R. Bell, MD; Christian Shenouda, MD. Disclosures: J. M. Zumsteg, No Disclosures. Objective: To compare the frequency and type of anti-epileptic drugs (AED) used during inpatient rehabilitation for acquired brain injury (ABI) between the years 1998 and 2008. Design: Retrospective chart review. Setting: University-based hospital inpatient rehabilitation unit.
Vol. 4, Iss. 10S, 2012
S201
Participants: 85 patients admitted to inpatient rehabilitation during calendar years 1998 and 2008 with ABI. Interventions: Not applicable. Main Outcome Measures: Demographics, AEDs upon admission and discharge. Results: In 1998 and 2008 patients admitted with ABI numbered 15 and 70, respectively. Brain injury diagnoses: brain neoplasm (43%), toxic/anoxic encephalopathy (17.44%), subarachnoid hemorrhage (16.28%), stroke (9.3%), traumatic brain injury (5.81%) and other (19.76%). On admission in 1998, four of 16 subjects had no AEDs, eight (50%) were taking phenytoin, and 6 were taking at least one other AED. Of the 70 admissions in 2008, 25 had no AEDs (35.71%), 26 were prescribed levetiracetam (37.14%), 12 were taking phenytoin (17.14%) and 12 subjects were taking other AEDs. Conclusions: Initial descriptive analysis of AED prescription frequency in ABI indicates that AEDs are commonly prescribed medications. While phenytoin was a common agent prescribed in 2008, the newer AED levetiracetam was prescribed more than twice as often. This study suggests the importance of understanding the efficacy and side effects of newer AEDs in those with ABI. A second study site will include additional data for ⬎300 subjects, allowing for more robust analysis between 1998 and 2008 data, including secondary analyses based on seizure characteristics and diagnosis. Poster 35 Association of Acute Neuroimaging Abnormalities and Headache in the First Year After Traumatic Brain Injury. Kathleen Bell, MD (University of Washington, Seattle, WA, United States); Jennifer Devine, MD; Sureyya Dikmen, PhD; Jeanne M. Hoffman, PhD; Sylvia Lucas, MD, PhD. Disclosures: K. Bell, Research grants: NIDRR, H133A070032. Objective: Examine the frequency of acute neuroimaging abnormalities and their association with headache severity and persistence in the first year after traumatic brain injury (TBI). Design: Prospective observational study. Setting: Inpatient rehabilitation (IR) and post discharge. Participants: 452 consecutive patients with TBI admitted to 7 TBI Model Systems IR units between February 2008 and June 2009. Interventions: Not applicable. Main Outcome Measures: Structured interview on headache status collected at IR, 3, 6 and 12 months post TBI. Acute injury head computed tomography (CT) was inventoried for 10 abnormalities: focal cortical/parenchymal contusion, focal non-cortical contusion, intraventricular hemorrhage (IVH), subarachnoid hemorrhage, skull, facial, or spine fracture, presence of extra-axial hematoma/hygroma (fluid), cistern compression/midline shift ⬎5mm, presence of imaging abnormalities at time of injury, early headache severity, and persistent headache (headaches at 3, 6 and 12 months post-TBI). Results: IVH was the most frequent abnormality (70%) noted on CT scans followed by focal contusions and presence of extra-axial fluid (both 60%). While skull fracture was less frequent (N⫽175), 41% with skull fracture reported moderate to severe headache during IR. Those who had mid-line shift (38%) and/or extra-axial fluid (34%) also reported higher rates of moderate to severe headache at IR. Complete headache information at all 3 time points was available for 273 of the 452 subjects and 63 (30%) of those subjects