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Poster 372: Chronic Syringomyelia Presenting as Brown-Sequard Syndrome After Blunt Trauma to the Spine: A Case Report
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Main Outcome Measures: Presence of osteoporosis and lower limb fractures. Results: In this study, 30 subjects were evaluated with average age at spinal cord injury 26.3 years and average of 64 months of injury. All patients had injury level between T2 and L1. Only 1 patient had lower limb fracture. Mean total calcium blood measure was 9.1 mmol/L, alkaline phosphatase (U/L) average 82.31 U/L, and ionized calcium 3.1 mmol/L. None of the patients had renal alterations with average of 0.54 mg/dL creatinine. Based on T score and z-score, 4 subjects (13.3%) had osteoporosis and 23.3% had osteopenia at lumbar spine, and average BMD ⫺0.46. Ten subjects (35.7%) had osteoporosis at total hip, and 10 subjects (35.7%) had osteopenia. All vitamin D, CTX, testosterone are still being analyzed. There were no statistical differences (using P⬍.05) between patients and control group regarding all laboratory analysis (the ones analyzed until now), and there were no correlations between BMD values and lower limb fracture. Conclusions: Despite the prevalence of total hip osteoporosis incidence, there was no correlation with lower limb fractures, leading us to discuss the value of the BMD measured at the same segments that we use for nondisabled patients and the real value to predict fractures in these kind of patients. There is a need to study this method of bone evaluation regarding osteoporosis in SCI patients, deciding who should be treated to avoid fractures and their complications.
Poster 372 Chronic Syringomyelia Presenting as BrownSequard Syndrome After Blunt Trauma to the Spine: A Case Report. Anterpreet Singh, MD (Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY); Andrei Dokukin, MD. Disclosures: A. Singh, None. Design: A case report. Patients or Programs: A 51-year-old man with no significant medical history presented with Brown-Sequard syndrome after pedestrian struck accident. Program Description: 51-year-old man was struck in the left leg by a moving car, then was ejected in the air and landed on right shoulder and back. On admission, he complained of feeling heaviness, tingling, and weakness in the left lower extremity as well as right lateral leg sensation loss. There was also numbness from mid chest downward R⬎L. There were no upper extremity symptoms or symptoms consistent with traumatic brain injury. Setting: Tertiary care university hospital, level 1 trauma center. Participants: 51-year-old man. Interventions: Rehabilitation. Main Outcome Measures: Improved motor functions. Results: On examination, patient had loss of propriocep-
PRESENTATIONS
tion in the left lower extremity and proximal left extremity weakness of 2/5 and 4/5 distally. There was sensory impairment below T4 level on the right side. His plantar reflexes were Babinski positive bilaterally, and there was hyperreflexia in bilateral ankle reflexes. An initial diagnosis of Brown-Sequard Syndrome was made. After ruling out acute pathology and/or fractures, he was started on a rehabilitation program. MRI cervical-thoracic-lumbar spine showed high signal intensity from T2 to T10-T11, which represented a chronic process like syringomyelia/hydromyelia rather than an acute change. Over the next few days, his motor strength improved to nearly normal. His plantar reflexes became downgoing, with loss of bilateral ankle reflexes, but sensory symptoms prevailed. Discussion: This is the first reported case, to our knowledge, of chronic syringomyelia presenting after blunt trauma as Brown-Sequard Syndrome with motor recovery in a few days. Conclusions: Chronic syrinx may be clinically silent until an inciting injury or trauma. It can also predispose to the development of a Brown-Sequard syndrome.
Poster 373 Diabetes, Spinal Cord Injury, and Functional Outcome: A Retrospective Study. Vanitha Asokan, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL); Vasilios Stambolis, MD. Disclosures: V. Asokan, None. Objective: To test hypothesis that diabetes mellitus (DM) adversely affects functional outcome in patients with traumatic and nontraumatic spinal cord injury (SCI) undergoing acute inpatient rehabilitation. Design: Retrospective study comparing functional outcome measures in diabetic and nondiabetic patients with SCI undergoing acute inpatient rehabilitation. Setting: Spinal Cord Injury Unit, Marianjoy Rehabilitation Hospital, Wheaton, IL. Participants: Patients (N⫽761) undergoing acute inpatient rehabilitation after SCI (N⫽164 diabetic and N⫽597 nondiabetic patients) in 2008 and 2009. Main Outcome Measures: Functional Independence Measure (FIM) cognitive, motor and total gains during inpatient stay; total FIM change and length of Stay. Results: Using chi-square analyses comparing SCI patients with and without DM types 1 or 2, we found no statistical significance in outcome measures. However, by using the same measures in comparing male and female diabetic patients, and male and female nondiabetic patients with SCI, there was a statistically significant difference (P⫽.022) in total motor gains made by female diabetic patients versus male diabetic patients, indicating that female diabetic patients undergoing acute inpatient rehabilitation after SCI made greater motor gains compared with their male counterparts. Comparatively, there was no statistically significant difference between male and female nondiabetic SCI patients.
Main Outcome Measures: Presence of osteoporosis and lower limb fractures. Results: In this study, 30 subjects were evaluated with average age at spinal cord injury 26.3 years and average of 64 months of injury. All patients had injury level between T2 and L1. Only 1 patient had lower limb fracture. Mean total calcium blood measure was 9.1 mmol/L, alkaline phosphatase (U/L) average 82.31 U/L, and ionized calcium 3.1 mmol/L. None of the patients had renal alterations with average of 0.54 mg/dL creatinine. Based on T score and z-score, 4 subjects (13.3%) had osteoporosis and 23.3% had osteopenia at lumbar spine, and average BMD ⫺0.46. Ten subjects (35.7%) had osteoporosis at total hip, and 10 subjects (35.7%) had osteopenia. All vitamin D, CTX, testosterone are still being analyzed. There were no statistical differences (using P⬍.05) between patients and control group regarding all laboratory analysis (the ones analyzed until now), and there were no correlations between BMD values and lower limb fracture. Conclusions: Despite the prevalence of total hip osteoporosis incidence, there was no correlation with lower limb fractures, leading us to discuss the value of the BMD measured at the same segments that we use for nondisabled patients and the real value to predict fractures in these kind of patients. There is a need to study this method of bone evaluation regarding osteoporosis in SCI patients, deciding who should be treated to avoid fractures and their complications.
Poster 372 Chronic Syringomyelia Presenting as BrownSequard Syndrome After Blunt Trauma to the Spine: A Case Report. Anterpreet Singh, MD (Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY); Andrei Dokukin, MD. Disclosures: A. Singh, None. Design: A case report. Patients or Programs: A 51-year-old man with no significant medical history presented with Brown-Sequard syndrome after pedestrian struck accident. Program Description: 51-year-old man was struck in the left leg by a moving car, then was ejected in the air and landed on right shoulder and back. On admission, he complained of feeling heaviness, tingling, and weakness in the left lower extremity as well as right lateral leg sensation loss. There was also numbness from mid chest downward R⬎L. There were no upper extremity symptoms or symptoms consistent with traumatic brain injury. Setting: Tertiary care university hospital, level 1 trauma center. Participants: 51-year-old man. Interventions: Rehabilitation. Main Outcome Measures: Improved motor functions. Results: On examination, patient had loss of propriocep-
PRESENTATIONS
tion in the left lower extremity and proximal left extremity weakness of 2/5 and 4/5 distally. There was sensory impairment below T4 level on the right side. His plantar reflexes were Babinski positive bilaterally, and there was hyperreflexia in bilateral ankle reflexes. An initial diagnosis of Brown-Sequard Syndrome was made. After ruling out acute pathology and/or fractures, he was started on a rehabilitation program. MRI cervical-thoracic-lumbar spine showed high signal intensity from T2 to T10-T11, which represented a chronic process like syringomyelia/hydromyelia rather than an acute change. Over the next few days, his motor strength improved to nearly normal. His plantar reflexes became downgoing, with loss of bilateral ankle reflexes, but sensory symptoms prevailed. Discussion: This is the first reported case, to our knowledge, of chronic syringomyelia presenting after blunt trauma as Brown-Sequard Syndrome with motor recovery in a few days. Conclusions: Chronic syrinx may be clinically silent until an inciting injury or trauma. It can also predispose to the development of a Brown-Sequard syndrome.
Poster 373 Diabetes, Spinal Cord Injury, and Functional Outcome: A Retrospective Study. Vanitha Asokan, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL); Vasilios Stambolis, MD. Disclosures: V. Asokan, None. Objective: To test hypothesis that diabetes mellitus (DM) adversely affects functional outcome in patients with traumatic and nontraumatic spinal cord injury (SCI) undergoing acute inpatient rehabilitation. Design: Retrospective study comparing functional outcome measures in diabetic and nondiabetic patients with SCI undergoing acute inpatient rehabilitation. Setting: Spinal Cord Injury Unit, Marianjoy Rehabilitation Hospital, Wheaton, IL. Participants: Patients (N⫽761) undergoing acute inpatient rehabilitation after SCI (N⫽164 diabetic and N⫽597 nondiabetic patients) in 2008 and 2009. Main Outcome Measures: Functional Independence Measure (FIM) cognitive, motor and total gains during inpatient stay; total FIM change and length of Stay. Results: Using chi-square analyses comparing SCI patients with and without DM types 1 or 2, we found no statistical significance in outcome measures. However, by using the same measures in comparing male and female diabetic patients, and male and female nondiabetic patients with SCI, there was a statistically significant difference (P⫽.022) in total motor gains made by female diabetic patients versus male diabetic patients, indicating that female diabetic patients undergoing acute inpatient rehabilitation after SCI made greater motor gains compared with their male counterparts. Comparatively, there was no statistically significant difference between male and female nondiabetic SCI patients.