PM&R
Poster 546 Anton Syndrome - Rare Complication of Cortical Blindness: A Case Report. Joseph Blazuk, (Schwab Rehabilitation Hospital, Chicago, IL, United States); Katherine Herzog, MD; Robert Lee, MD. Disclosures: J. Blazuk, No Disclosures. Case Description: A 58-year-old man with history of coronary artery disease, hypertension, seizures and multiple strokes presented to the emergency room with confusion. Computed tomography (CT) of head revealed chronic infarcts in the right frontal lobe and left occipital area. Magnetic resonance imaging (MRI) of brain revealed acute bilateral occipital lobe infarcts. Echocardiogram showed an ejection fraction of 10-15% and an apical thrombus in the left ventricle that was managed with Coumadin. On physical examination, extraocular movements were intact and pupils accommodated to light symmetrically. Difficulty naming objects and finger agnosia was noted. He adamantly denied vision problems and was diagnosed with Anton Syndrome. Given poor safety, impulsivity, and impaired balance, the patient was referred to acute inpatient rehabilitation. Setting: Acute inpatient rehabilitation hospital. Results or Clinical Course: Initially, he incorrectly named shapes and colors and could not locate objects in the room. During the rehabilitation course, his ability to recognize shapes and shades of color improved; he could read time on a clock and avoid obstacles when ambulating. He became aware of his visual deficits on the third day of rehab. At discharge, he could negotiate a flight of stairs and perform all ADLs and transfers with supervision. Discussion: Cortical blindness is loss of vision caused by insults to the occipital visual cortex, bilaterally. Visual agnosognosia, Anton syndrome, is a rare complication of cortical blindness that results from injury to the visual association cortex. It is characterized by denial of blindness and preserved pupillary reaction. Patients commonly confabulate explanations for their vision problems, are impulsive and have decreased safety awareness. Conclusions: Anton’s Syndrome is a rare neurological disorder where patients benefit substantially from inpatient rehabilitation. Poster 547 Conceptual Design and Content Validation of a Screening Tool to Detect Disabling Spasticity in Stroke Survivors. Kari Dunning, PT, PhD (University of Cincinnati, Cincinnati, OH, United States); Mark J. Atkinson, PhD; Lisa D’Ambrosio, PhD; Patrick J. Gillard, PhD, MS; Brett Kissela, MD, MS; Maureen Mohyde, MA; Sepideh F. Varon, PhD; Richard D. Zorowitz, MD. Disclosures: K. Dunning, Consulting fees: ⬍$3000 in consulting and service fees associated with this study. Objective: To identify the conceptual dimensions and content for development of a screening tool able to discriminate between disabling and non-disabling spasticity in stroke survivors. Design: Clinicians with expertise in post stroke spasticity (PSS) took part in telephone interviews to determine the scales available to clinically assess spasticity and how stroke survivors understood and described spastic symptoms. Interview transcripts were used to draft a preliminary conceptual framework, which was then refined using three multi-site focus groups consisting of stroke survivors
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with spasticity. A thematic frequency analysis of the focus group transcripts highlighted common characteristics of PSS and was used to both finalize the conceptual framework and create test items for the screen. Readability and comprehension were assessed through cognitive interviews with 10 stroke survivors with spasticity. Setting: Telephone interviews, multi-site focus groups and cognitive interviews. Participants: 13 clinicians with expertise in PSS; 29 stroke survivors with spasticity in the upper and/or lower limbs and mild to moderate stroke severity (National Institutes of Health Stroke Scale score ⬍17). Interventions: Not applicable. Main Outcome Measures: Not applicable. Results: The finalized conceptual framework describes the interrelationships between PSS symptoms and disability. Focus group participants described a variety of muscle symptoms and movement difficulties in upper and lower limbs that contributed to disability in their daily life. A number of factors were identified that moderate the degree of symptom distress. This information was used to create a draft item pool for the PSS screener, with readability and comprehension confirmed in the cognitive interviews. Conclusions: Stroke survivors with spasticity provided a robust matrix of PSS symptoms/characteristics sufficient to design a screening tool to detect disabling spasticity. Further measurement design activities will select those items for the final measure that best discriminate between stroke survivors with disabling spasticity and those with non-disabling spasticity. Poster 548 Vexing Visual Deficits: Features of Balint’s Syndrome in a Patient with Moyamoya Disease. A Case Report. Kristofer J. Feeko, DO (Thomas Jefferson University, Philadelphia, PA, United States); Elizabeth Adamov, MS-IV; Joshua S. Armstrong, DO; Barbara Browne, MD; Katie Falzone, OTR/L. Disclosures: K. J. Feeko, No Disclosures. Case Description: A 53-year-old tetraparetic woman with multiple bilateral strokes from progressive Moyamoya disease presenting with hand-eye incoordination. Program Description: Since initial diagnosis at age 36, the patient’s disease course was marked by recurrent ischemic events. At acute presentation, imaging demonstrated advanced vascular disease with non-visualization of normal intracranial vasculature, with near obliteration of most of the internal carotid artery/middle cerebral artery territory and significant leptomeningeal collateralization. The patient was noted to have new left-sided ischemia with resultant worsening of her right hemiparesis. She underwent leftsided encephaloduroarteriosynagiosis procedure for advanced stenosis. Rehabilitation admission was notable for decreased functional independence due to ocular apraxia. Setting: Free-standing rehabilitation hospital. Results or Clinical Course: Early Moyamoya disease course is characterized by mild to moderate vessel narrowing with reactive collateralization, described as having a “puff of smoke” appearance on contrast study. With advanced disease, both collateralization and normal architecture are lost due to complete vessel stenosis; collateralization stems from existing external carotid or posterior circulation. In advanced disease, due to the presence of new posterior