- Email: [email protected]
Unilateral Krukenberg Procedure in a Quadruple Amputee; Independence after Rehabilitation: A Case Report
S174
Poster 99 Post-Partum Coronary Artery Dissection and the Role of Hormones on Connective Tissue: A Case Report. Roshni G. Durgam, MD (Albert Einstein College of Medicine / Montefiore, Bronx, NY, United States); Antigone Argyriou, MD; Anna M. Lasak, MD. Disclosures: R. G. Durgam, No Disclosures: I Have Nothing To Disclose. Case Description: We report a case of a previously healthy 38-year-old woman, 11 days post-partum, who presented to our medical center with acute onset of chest pain and acute STelevations on EKG. Subsequently, angiogram performed revealed left main coronary artery dissection. She underwent double vessel bypass graft for therapeutic intervention. Herein, we will focus on the presentation of this rare condition and discuss the role of hormones on connective tissue and its further implications into musculoskeletal conditions. Setting: Tertiary care center Results or Clinical Course: After our patient underwent cardiac intervention and was medically optimized, she was later transferred to an acute inpatient rehabilitation unit to maximize function. Once she met all of her rehabilitation goals, she was eventually discharged home with close follow up. Discussion: Spontaneous coronary artery dissection (SCAD) is an extremely rare, at times fatal, cause of acute coronary syndrome. It most commonly presents in young women who are peri- or post partum. Though the precise etiology of post partum coronary artery dissection has yet to be identified, hemodynamic changes aside, one of the proposed theories is the effect hormonal variations have on connective tissue. Past studies have shown that there are known estrogen receptors present on structures ranging from the tunica media of the aorta to the anterior cruciate ligament (ACL) of the knee. These studies have shown that lower estrogen level conditions or a rapid decline in estrogen levels predispose to connective tissue laxity. This can lead to increased incidences of ACL tears, or in this case, coronary artery dissection. Further evidence to support this correlation is the association of SCAD in women who are menstruating and in those who use oral contraceptives pills. Conclusions: SCAD is a life-threatening condition that requires immediate medical attention. It should be considered in young women who present with acute onset of chest pain. Women’s rehabilitation is an expanding sub-specialty and further investigations into the role of hormonal changes on connective tissue could provide meaningful insight to certain female-predominant conditions. Poster 100 Unilateral Krukenberg Procedure in a Quadruple Amputee; Independence after Rehabilitation: A Case Report. Catherine J. Yee (Schwab Rehabilitation Hospital, Chicago, IL, United States); Michael Massey, DO; Theresa Lie-Nemeth, MD; Michelle Gittler, MD. Disclosures: C. J. Yee, No Disclosures: I Have Nothing To Disclose. Case Description: Patient: A 49-year old right-handed man who had acute inpatient rehabilitation following Krukenberg procedure to the right arm. The patient presented with acute respiratory failure from necrotizing pneumonia, progressed to septic shock and developed dry gangrene of all extremities due to vasopressor therapy
PRESENTATIONS
for gastrointestinal hemorrhage. He was stabilized, lines of demarcation formed in the gangrenous limbs, and revision amputations and Krukenberg procedure on the right arm were performed. He was transferred to acute inpatient rehabilitation for therapy and training in Activities of Daily Living, returned to a skilled nursing facility for wound healing, and was re-admitted for prosthesis training and re-education in movements of pronation and supination in apposing the radius to the fixed ulna to achieve pincer and grasping and prevent rotary and scissoring movements. Setting: Acute rehabilitation hospital. Results or Clinical Course: He was discharged home modifiedindependent for donning/doffing bilateral leg prostheses with vice grips and increased time, upper body dressing, toileting and toilet transfers; setup to open packages without splints or mouth, simple meal preparation, eating with left arm while cutting food with right arm extension splints. At outpatient follow up, he demonstrated improved power and coordination in the Krukenberg limb. Discussion: The Krukenberg procedure is rarely performed in developed countries due to cosmesis compared to available prostheses; however, it can be functionally advantageous by preserving tactile sensibility, proprioception, and stereognosis, allowing for effective maneuvering without excluding the use of a myoelectric prosthesis. It creates a pinch at forearm level by opposing the radius and the ulna. Conclusions: The Krukenberg hand is a functional alternative in patients without access to or funds for functional prostheses that allows for independence in daily tasks. It should be offered to distal arm amputees as an option to prosthetics as it can offer greater functionality. Poster 101 Tropical Spastic Paraparesis: A Case Report. Fajie Ma (SUNY Downstate, Brooklyn, NY, United States); Anatoly Shnayder, MD; Getahum Kifle, MD; Sanjeev Agarwal, MD. Disclosures: F. Ma, No Disclosures: I Have Nothing To Disclose. Case Description: The patient is a 23-year- old female with PMH of asthma and gestational diabetes who was admitted with a 6-month history of back pain, bilateral lower extremity weakness, stiffness and incontinence of bladder. Her gait progressively worsened requiring the use of cane. The neurological examination was positive for right arm drift, increased tone in bilateral lower extremities, MMT 5/5 in the left UE and 4/5 in the right UE and 3þ DTR in bilateral LE with upgoing plantars. Patient was unable to walk without support. The MRI of whole spine with/without contrast was unremarkable. MRI of the brain with contrast revealed heterogeneous T1 hypointense signal and enhancement within the medulla but were nonspecific. Serum ANA - Qual was positive, Anti RNP positive, Anti - Sc1-70 positive, HTLV-I / HTLV-II reactive, Vit B12 WNL, CSF slightly increased protein. Setting: Tertiary medical center Results or Clinical Course: The patient was started on PO baclofen and pain medication with improvement in spasticity and gait dysfunction in 2 weeks. Discussion: Tropical spastic paraparesis is a rare myelopathic disorder associated with HTLV-I/HTLV-II infections. It is characterized by an insidious onset of slowly progressive weakness and spasticity of one or both legs, together with hyperreflexia, ankle clonus, extensor plantar responses, and low back pain. Other
Poster 99 Post-Partum Coronary Artery Dissection and the Role of Hormones on Connective Tissue: A Case Report. Roshni G. Durgam, MD (Albert Einstein College of Medicine / Montefiore, Bronx, NY, United States); Antigone Argyriou, MD; Anna M. Lasak, MD. Disclosures: R. G. Durgam, No Disclosures: I Have Nothing To Disclose. Case Description: We report a case of a previously healthy 38-year-old woman, 11 days post-partum, who presented to our medical center with acute onset of chest pain and acute STelevations on EKG. Subsequently, angiogram performed revealed left main coronary artery dissection. She underwent double vessel bypass graft for therapeutic intervention. Herein, we will focus on the presentation of this rare condition and discuss the role of hormones on connective tissue and its further implications into musculoskeletal conditions. Setting: Tertiary care center Results or Clinical Course: After our patient underwent cardiac intervention and was medically optimized, she was later transferred to an acute inpatient rehabilitation unit to maximize function. Once she met all of her rehabilitation goals, she was eventually discharged home with close follow up. Discussion: Spontaneous coronary artery dissection (SCAD) is an extremely rare, at times fatal, cause of acute coronary syndrome. It most commonly presents in young women who are peri- or post partum. Though the precise etiology of post partum coronary artery dissection has yet to be identified, hemodynamic changes aside, one of the proposed theories is the effect hormonal variations have on connective tissue. Past studies have shown that there are known estrogen receptors present on structures ranging from the tunica media of the aorta to the anterior cruciate ligament (ACL) of the knee. These studies have shown that lower estrogen level conditions or a rapid decline in estrogen levels predispose to connective tissue laxity. This can lead to increased incidences of ACL tears, or in this case, coronary artery dissection. Further evidence to support this correlation is the association of SCAD in women who are menstruating and in those who use oral contraceptives pills. Conclusions: SCAD is a life-threatening condition that requires immediate medical attention. It should be considered in young women who present with acute onset of chest pain. Women’s rehabilitation is an expanding sub-specialty and further investigations into the role of hormonal changes on connective tissue could provide meaningful insight to certain female-predominant conditions. Poster 100 Unilateral Krukenberg Procedure in a Quadruple Amputee; Independence after Rehabilitation: A Case Report. Catherine J. Yee (Schwab Rehabilitation Hospital, Chicago, IL, United States); Michael Massey, DO; Theresa Lie-Nemeth, MD; Michelle Gittler, MD. Disclosures: C. J. Yee, No Disclosures: I Have Nothing To Disclose. Case Description: Patient: A 49-year old right-handed man who had acute inpatient rehabilitation following Krukenberg procedure to the right arm. The patient presented with acute respiratory failure from necrotizing pneumonia, progressed to septic shock and developed dry gangrene of all extremities due to vasopressor therapy
PRESENTATIONS
for gastrointestinal hemorrhage. He was stabilized, lines of demarcation formed in the gangrenous limbs, and revision amputations and Krukenberg procedure on the right arm were performed. He was transferred to acute inpatient rehabilitation for therapy and training in Activities of Daily Living, returned to a skilled nursing facility for wound healing, and was re-admitted for prosthesis training and re-education in movements of pronation and supination in apposing the radius to the fixed ulna to achieve pincer and grasping and prevent rotary and scissoring movements. Setting: Acute rehabilitation hospital. Results or Clinical Course: He was discharged home modifiedindependent for donning/doffing bilateral leg prostheses with vice grips and increased time, upper body dressing, toileting and toilet transfers; setup to open packages without splints or mouth, simple meal preparation, eating with left arm while cutting food with right arm extension splints. At outpatient follow up, he demonstrated improved power and coordination in the Krukenberg limb. Discussion: The Krukenberg procedure is rarely performed in developed countries due to cosmesis compared to available prostheses; however, it can be functionally advantageous by preserving tactile sensibility, proprioception, and stereognosis, allowing for effective maneuvering without excluding the use of a myoelectric prosthesis. It creates a pinch at forearm level by opposing the radius and the ulna. Conclusions: The Krukenberg hand is a functional alternative in patients without access to or funds for functional prostheses that allows for independence in daily tasks. It should be offered to distal arm amputees as an option to prosthetics as it can offer greater functionality. Poster 101 Tropical Spastic Paraparesis: A Case Report. Fajie Ma (SUNY Downstate, Brooklyn, NY, United States); Anatoly Shnayder, MD; Getahum Kifle, MD; Sanjeev Agarwal, MD. Disclosures: F. Ma, No Disclosures: I Have Nothing To Disclose. Case Description: The patient is a 23-year- old female with PMH of asthma and gestational diabetes who was admitted with a 6-month history of back pain, bilateral lower extremity weakness, stiffness and incontinence of bladder. Her gait progressively worsened requiring the use of cane. The neurological examination was positive for right arm drift, increased tone in bilateral lower extremities, MMT 5/5 in the left UE and 4/5 in the right UE and 3þ DTR in bilateral LE with upgoing plantars. Patient was unable to walk without support. The MRI of whole spine with/without contrast was unremarkable. MRI of the brain with contrast revealed heterogeneous T1 hypointense signal and enhancement within the medulla but were nonspecific. Serum ANA - Qual was positive, Anti RNP positive, Anti - Sc1-70 positive, HTLV-I / HTLV-II reactive, Vit B12 WNL, CSF slightly increased protein. Setting: Tertiary medical center Results or Clinical Course: The patient was started on PO baclofen and pain medication with improvement in spasticity and gait dysfunction in 2 weeks. Discussion: Tropical spastic paraparesis is a rare myelopathic disorder associated with HTLV-I/HTLV-II infections. It is characterized by an insidious onset of slowly progressive weakness and spasticity of one or both legs, together with hyperreflexia, ankle clonus, extensor plantar responses, and low back pain. Other