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Poster 528 Metastatic Methicillin-Resistant Staphylococcal Aureus Infection and Incomplete Paraplegia Following Epidural Steroid Injections: A Case Report
PM&R
bilateral lower extremity weakness, diminished sensation including loss of proprioception, pain and temperature and bladder and bowel impairments, although she could void voluntarily. The patient was diagnosed with posterior spinal artery syndrome with an American Spinal Injury Association (ASIA) Classification D at L1. Setting: Tertiary care hospital Results or Clinical Course: After 3 weeks including 2 weeks of rehabilitation, patient only had persistence of bilateral lower extremity proprioception loss. MRI did not reveal any findings. Due to the risk of vasospasm, CT angiogram was deferred as it would not change treatment. Discussion: Distal posterior spinal artery infarction tends to effect the watershed area of L1. Conclusions: Posterior spinal artery syndrome is rarely reported. This is the first reported case, to our knowledge, of posterior spinal artery syndrome following suction dilation and curettage with spinal anesthesia. Poster 527 Low Back Pain With Mixed Upper and Lower Motor Neuron Deficits. Diastematomyelia: A Case Report. Yan Gu, MD, PhD (Temple University Hospital, Philadelphia, PA, United States); Ernesto S. Cruz, MD; Jamie L. Schmeer, DO; David S. Stolzenberg, DO. Disclosures: Y. Gu, No Disclosures. Case Description: A 30-year-old woman has a 15-year history of slowly progressive low back and leg pain. She started to have unsteady gait and worsening left leg pain for 10 days. Physical examination revealed typical upper neuron signs in right lower limb and lower motor neuron signs in left. Setting: Tertiary and acute rehabilitation hospital. Results or Clinical Course: Cervical MRI showed increased T2 signal in the spinal cord at C7. Lumbar MRI revealed a split cord at the L1/L2 region as well as tethering of the lumbrosacral cord. The patient underwent an L2 to L5 laminectomy with exploration of diastematomyelia and cord untethering procedure. Fibrous bands were found at the base of the spinal cord. Discussion: Insidious symptoms are often ignored by patients and physicians, especially with the younger patient population. Early diagnosis of a treatable disease is important to prevent the progression of the pathology, long-term rehabilitation needs and permanent deficits. Diastematomyelia is a rare congenital anomaly that results in the splitting of the spinal cord in a longitudinal direction. This patient had a tethered spinal cord at the base and L4-5 which caused a stretch injury of the spinal cord up in cervical level. Unique manifestations with both upper and lower motor neuron signs on different sides of the body were found. Tethered spinal cords are common in this group of patients, but it is unusual for this specific patient to have such a long and insidious process. Conclusions: We are reporting a rare disorder, diastematomyelia, with a tethered spinal cord. The patient had a very long, insidious and slow progressive history of low back pain and developed unique manifestations with both upper neuron signs in one side of the body and lower neuron signs in other.
Vol. 4, Iss. 10S, 2012
S371
Poster 528 Metastatic Methicillin-Resistant Staphylococcal Aureus Infection and Incomplete Paraplegia Following Epidural Steroid Injections: A Case Report. Yogita Tailor, DO (Sinai Hospital of Baltimore, Baltimore, MD, United States); Henry S. York, MD. Disclosures: Y. Tailor, No Disclosures. Case Description: The patient presented to an acute-care hospital with severe, progressive low back pain 2 weeks after receiving epidural steroid injections (ESIs) to treat third and fourth lumbar (L3-4) disk herniation. She was found to have Methicillin-Resistant Staphylococcal aureus (MRSA) epidural and iliacus muscle abscesses, bacteremia, mitral valve and interventricular septum vegetations, empyema, right hip and shoulder osteomyelitis, and multiple septic emboli to her right lung, intestines, spleen, kidneys, and left eye, which led to multisystem organ failure and chorioretinitis. She had no history of prior infections, immune system dysfunction, or high-risk behaviors. During her 2-month hospitalization, which was complicated by asystole and a non-displaced hip fracture, she received ventilator support, intravenous antibiotics, empyema drainage, sternotomy and mitral valve vegetation removal, coronary artery bypass grafting, and L3-4 laminectomy and epidural and paraspinal muscle abscess washouts. Program Description: 51-year-old woman with history of chronic low back pain. Setting: Freestanding rehabilitation hospital. Results or Clinical Course: Neurological examination upon admission to comprehensive inpatient rehabilitation revealed an L3 motor incomplete paraplegic spinal cord injury (SCI). Rehabilitation progress was limited by sternal precautions and significant pain, which resulted in her requiring maximal assistance with mobility. After discharge, she required right femoral head ostectomy with antibiotic bead therapy and additional intravenous antibiotics. She eventually returned home but then developed a pulmonary embolus and axillary abscesses. Discussion: Common complications of ESIs include local infection and pain. This is a unique description of a patient who developed multiple fulminant infectious and medical complications resulting from ESIs. In addition to providing functional benefit, comprehensive inpatient SCI rehabilitation provided additional time for antibiotic administration, coordination of medical followup, patient education, and family training. Conclusions: Physicians and patients must be aware of potential complications of ESIs, which can catastrophically affect function and quality of life.
STROKE Poster 530 Acute Embolic Stroke in a Patient with Q Fever Endocarditis: A Case Report. Alexandra Ilkevitch (University of Wisconsin Hospital and Clinics, Madison, WI, United States); Tommy Yu, MD. Disclosures: A. Ilkevitch, No Disclosures. Case Description: A 75-year-old man with coronary artery disease status post coronary artery bypass graft surgery and bioprosthetic valve, who presented with acute of onset of right hemiparesis
bilateral lower extremity weakness, diminished sensation including loss of proprioception, pain and temperature and bladder and bowel impairments, although she could void voluntarily. The patient was diagnosed with posterior spinal artery syndrome with an American Spinal Injury Association (ASIA) Classification D at L1. Setting: Tertiary care hospital Results or Clinical Course: After 3 weeks including 2 weeks of rehabilitation, patient only had persistence of bilateral lower extremity proprioception loss. MRI did not reveal any findings. Due to the risk of vasospasm, CT angiogram was deferred as it would not change treatment. Discussion: Distal posterior spinal artery infarction tends to effect the watershed area of L1. Conclusions: Posterior spinal artery syndrome is rarely reported. This is the first reported case, to our knowledge, of posterior spinal artery syndrome following suction dilation and curettage with spinal anesthesia. Poster 527 Low Back Pain With Mixed Upper and Lower Motor Neuron Deficits. Diastematomyelia: A Case Report. Yan Gu, MD, PhD (Temple University Hospital, Philadelphia, PA, United States); Ernesto S. Cruz, MD; Jamie L. Schmeer, DO; David S. Stolzenberg, DO. Disclosures: Y. Gu, No Disclosures. Case Description: A 30-year-old woman has a 15-year history of slowly progressive low back and leg pain. She started to have unsteady gait and worsening left leg pain for 10 days. Physical examination revealed typical upper neuron signs in right lower limb and lower motor neuron signs in left. Setting: Tertiary and acute rehabilitation hospital. Results or Clinical Course: Cervical MRI showed increased T2 signal in the spinal cord at C7. Lumbar MRI revealed a split cord at the L1/L2 region as well as tethering of the lumbrosacral cord. The patient underwent an L2 to L5 laminectomy with exploration of diastematomyelia and cord untethering procedure. Fibrous bands were found at the base of the spinal cord. Discussion: Insidious symptoms are often ignored by patients and physicians, especially with the younger patient population. Early diagnosis of a treatable disease is important to prevent the progression of the pathology, long-term rehabilitation needs and permanent deficits. Diastematomyelia is a rare congenital anomaly that results in the splitting of the spinal cord in a longitudinal direction. This patient had a tethered spinal cord at the base and L4-5 which caused a stretch injury of the spinal cord up in cervical level. Unique manifestations with both upper and lower motor neuron signs on different sides of the body were found. Tethered spinal cords are common in this group of patients, but it is unusual for this specific patient to have such a long and insidious process. Conclusions: We are reporting a rare disorder, diastematomyelia, with a tethered spinal cord. The patient had a very long, insidious and slow progressive history of low back pain and developed unique manifestations with both upper neuron signs in one side of the body and lower neuron signs in other.
Vol. 4, Iss. 10S, 2012
S371
Poster 528 Metastatic Methicillin-Resistant Staphylococcal Aureus Infection and Incomplete Paraplegia Following Epidural Steroid Injections: A Case Report. Yogita Tailor, DO (Sinai Hospital of Baltimore, Baltimore, MD, United States); Henry S. York, MD. Disclosures: Y. Tailor, No Disclosures. Case Description: The patient presented to an acute-care hospital with severe, progressive low back pain 2 weeks after receiving epidural steroid injections (ESIs) to treat third and fourth lumbar (L3-4) disk herniation. She was found to have Methicillin-Resistant Staphylococcal aureus (MRSA) epidural and iliacus muscle abscesses, bacteremia, mitral valve and interventricular septum vegetations, empyema, right hip and shoulder osteomyelitis, and multiple septic emboli to her right lung, intestines, spleen, kidneys, and left eye, which led to multisystem organ failure and chorioretinitis. She had no history of prior infections, immune system dysfunction, or high-risk behaviors. During her 2-month hospitalization, which was complicated by asystole and a non-displaced hip fracture, she received ventilator support, intravenous antibiotics, empyema drainage, sternotomy and mitral valve vegetation removal, coronary artery bypass grafting, and L3-4 laminectomy and epidural and paraspinal muscle abscess washouts. Program Description: 51-year-old woman with history of chronic low back pain. Setting: Freestanding rehabilitation hospital. Results or Clinical Course: Neurological examination upon admission to comprehensive inpatient rehabilitation revealed an L3 motor incomplete paraplegic spinal cord injury (SCI). Rehabilitation progress was limited by sternal precautions and significant pain, which resulted in her requiring maximal assistance with mobility. After discharge, she required right femoral head ostectomy with antibiotic bead therapy and additional intravenous antibiotics. She eventually returned home but then developed a pulmonary embolus and axillary abscesses. Discussion: Common complications of ESIs include local infection and pain. This is a unique description of a patient who developed multiple fulminant infectious and medical complications resulting from ESIs. In addition to providing functional benefit, comprehensive inpatient SCI rehabilitation provided additional time for antibiotic administration, coordination of medical followup, patient education, and family training. Conclusions: Physicians and patients must be aware of potential complications of ESIs, which can catastrophically affect function and quality of life.
STROKE Poster 530 Acute Embolic Stroke in a Patient with Q Fever Endocarditis: A Case Report. Alexandra Ilkevitch (University of Wisconsin Hospital and Clinics, Madison, WI, United States); Tommy Yu, MD. Disclosures: A. Ilkevitch, No Disclosures. Case Description: A 75-year-old man with coronary artery disease status post coronary artery bypass graft surgery and bioprosthetic valve, who presented with acute of onset of right hemiparesis