PM&R Vol. 5, Iss. 9S, 2013 S261

Poster 354An Unlikely Cause of Acute Paraplegia and LethargyFollowing Lumbar Laminectomy: A Case Report.Kelly Armstrong, MD (Mayo Clinic, Rochester, MN,United States); Billie A. Schultz, MD.

Disclosures: K. Armstrong, No Disclosures: I Have Nothing ToDisclose.Case Description: A 71-year-old patient underwent L4 bilaterallaminectomy at an outside hospital for back and leg pain. She hadimprovement of symptoms for one month and was able to ambulatewith a cane. She then developed severe back and leg pain withbowel and bladder dysfunction. She was diagnosed with inflam-matory postsurgical neuropathy and treated with high dosesteroids. She developed fever resistant to broad spectrum antibiotictherapy and was found to have anemia and thrombocytopenia.Bone marrow biopsy showed iron deficiency. Narcotic pain medi-cations were given and she was dismissed. Four months later shepresented to OSH with progressive paraparesis, urinary inconti-nence, and lethargy. MRI spine/brain was negative. The patient’sneurologic exam continued to decline although there was mildimprovement with high dose steroid and IVIg treatment forpresumed AIDP. The patient was transferred to our institutionshowing flaccid tone and absent reflexes in lower extremities withminimal movement. She was minimally responsive. Lab evaluationshowed anemia, thrombocytopenia, hyponatremia, and elevatedalkaline phosphatase. CSF analysis showed elevated total protein.MRI spine showed T2 intensity of conus medullaris with multipleenhancing cauda equina nerve roots. MRI brain showed signalabnormality in the pons consistent with osmotic demyelination.Bone marrow biopsy showed hypercellular marrow with hemo-phagocytosis and lymph node biopsy showed intravascular B celllymphoma. The patient began chemotherapy and comprehensiverehabilitation.Setting: Tertiary care inpatient hospital.Results or Clinical Course: Our hematology service providedchemotherapy treatment. Initial high dose steroid treatmentproduced modest recovery in lower extremity paresis andimprovement in mental status. Further developments afterchemotherapy will be discussed.Discussion: This is a rare example of the difficult diagnosis ofintravascular B cell lymphoma presenting as a central neurologicdisorder which, if caught and treated earlier, would impact patientoutcomes and functional recovery.Conclusions: Intravascular lymphoma (IVL) is a rare butimportant cause of myelopathy that should be considered as earlydiagnosis relates directly to long term functional impairment. Ifdiagnosis is made early, chemotherapy may be curative.

Poster 355Postencephalitic Parkinsonism in Acute InpatientRehabilitation: A Case Report.Julie Chow (Rehabilitation Institute of Chicago /McGaw Medical Center of Northwestern University,Chicago, IL, United States); Samuel K. Chu, MD; NenadBrkic, MD.

Disclosures: J. Chow, No Disclosures: I Have Nothing ToDisclose.Case Description: A 61-year-old man with history of non-Hodgkins lymphoma in remission was admitted to an outside

hospital for acute decline in mental status, headache, and fever. CTand MRI brain were unremarkable, CSF initially showed mildpleocytosis with lymphocytic predominance. Antibiotics and anti-virals were empirically started. On day 5, he was noted to be bra-dykinetic and had rigid upper extremities, diminished speech. Healso developed masticatory myorhythmias. Infectious workup wasnegative, and antibiotics/antivirals were discontinued. Paraneo-plastic syndrome was ruled out with imaging, serum and CSFstudies. EEG was negative for epileptiform activity. Cerebral angi-ography was negative for vasculitis. DaTSCAN showed asymmetricuptake in the putamen suggestive of parkinsonian syndrome.Carvidopa/levodopa was started with improvement in symptoms,and ropinirole was later added.Setting: Acute inpatient rehabilitation (AIR) hospital.Results or Clinical Course: The patient was admitted to AIRafter 2 months. On exam, he was awake, able to answer questionswith head nods, occasional shouted responses. He had 5/5 strengthbilateral upper extremities, 3/5 hip flexion, knee flexion/extension,0/5 ankle dorsiflexion, plantarflexion bilaterally. He had slowedmovement with finger to nose. On initial therapy evaluation, he wasnon-ambulatory, required moderate assistance (Mod A) for eating,maximum assist (Max A) for upper body dressing, total assist forlower body dressing and toileting. Admission Functional Inde-pendence Measure (FIM) score was 28. On discharge, he wasambulatory for 12 feet with Mod A, required minimal assistance forupper body dressing, Max A for lower body dressing and toileting.He made gains in expression, social interaction and problemsolving. Discharge FIM score was 47 with a FIM gain of 19, FIMefficiency of 0.68 (length of stay 28 days). The patient was main-tained on carvidopa/levodopa and ropinirole.Discussion: This is a unique case of parkinsonism after enceph-alitis of unknown etiology. There are no reports in the literatureregarding rehabilitation outcomes for patients with post-encepha-litic parkinsonism. The patient in our case made functional gainsduring AIR.Conclusions: Patients with parkinsonism after encephalitis ofunknown etiology can benefit from acute inpatient rehabilitation.

Poster 356Conus Medullaris Spinal Cord Injury (SCI) withoutRadiologic Abnormality (SCIWORA) in a YoungCheerleader: A Case Report.Christopher Clark, MD (Sinai Hospital of Baltimore, Bal-timore, MD, United States); Henry S. York, MD.

Disclosures: C. Clark, No Disclosures: I Have Nothing ToDisclose.Case Description: A 16-year-old high school cheerleader wasthrown into the air during a stunt but not caught. She landed onher sacrum onto a 3-inch thick mat. She immediately noticed severeback pain and inability to move or feel her legs. At an acutehospital, inspection of her spine and limbs revealed no deformities.Upper limbs had normal strength and sensation. Lower limbs hadno active movement except for trace movement in her left small toeand right second toe. She was insensate below bilateral L1dermatomes. Rectal tone and sensation was intact. All imagingstudies revealed no evidence of abnormalities. She was admittedand placed on bed rest. Within 48 hours, she could dorsiflex andplantarflex her right ankle and had trace movement in her leftankle; sensation returned in her right L4 to S2 dermatomes. By 72