which PS levels are nearly normal, yet its activity is markedlyreduced.Conclusions: This case demonstrates the diagnosis of PSdeficiency can be very difficult and at times challenging tomake. Rehabilitation physicians should be vigilant andshould not hesitate to look for PS deficiency in patients withrecurrent strokes.

Poster 452Leftward Walking Deviation After Right-Hemisphere Stroke: A Case Report.Bethany M. Lipa, MD (University of Medicineand Dentistry of New Jersey, Newark, NJ); BarrettM. Anna, MD; Peii Chen, PhD; Cristin McKenna;Naureen Zaidi.

Disclosures: B. M. Lipa, None.Patients or Programs: 41-year-old, left-handed womanwith spatial neglect.Program Description: Patient presented with com-plaints of intermittent headache and acute onset disorienta-tion and dizziness. She subsequently developed left facialdroop, hemiplegia, and neglect. Imaging revealed an acuteright middle cerebral artery territory infarction and a largethrombus within the right internal carotid artery. Upontransfer to acute rehabilitation, she was alert, dysarthric, hadleft spatial neglect, poor sitting balance, and ADL dysfunc-tion. During her stay, motor function improved, and, upondischarge, she was ambulating with modified independence.A leftward bias was observed on line bisection performance.On forward walking task performed in a neutral visual stim-ulation environment with eyes opened, a leftward walkingdeviation was noted. When blindfolded, she did not consis-tently deviate. Contrary to actual performance, she reportedveering rightward during the test.Setting: Acute rehabilitation center.Results: Spatial neglect significantly affected the functionalrecovery of our patient. Both line bisection and a forwardwalking task with eyes opened revealed leftward deviation.Discussion: Patients with neglect have been shown todemonstrate abnormal deviation in walking. Interacting withand navigating through the environment requires spatialupdating of body position in visual surroundings. Spatialupdating may be asymmetrical in spatial neglect. Prior liter-ature suggests that patients with spatial neglect rely mainlyon representation of the destination located in far spaceversus perceptual information. Our patient revealed thatwalking deviation is primarily perceptual rather than repre-sentational because blindfolding did not cause deviation inforward walking. If walking deviation depended first uponrepresentation, the patient would deviate similarly regardlessof blindfolding status.Conclusions: Spatial neglect is a disabling disorder oftenunderdiagnosed clinically. Walking deviation is a potentialdeficit that should be recognized. This case suggests that

patients with spatial neglect may rely on perceptual informa-tion rather than representation of a destination when navi-gating their environment.

Poster 453Right Middle Cerebral Artery Infarct in a ManWith Diagnosed Neurosarcoidosis: A CaseReport.Dhanu Panchal (Marianjoy, Wheaton, IL); RichardKrieger, MD.

Disclosures: D. Panchal, None.Patients or Programs: 69-year-old man with a 15-yearhistory of biopsy-confirmed neurosarcoidosis presented withleft hemiparesis from his second stroke.Program Description: The patient presented with lefthemiparesis and expressive aphasia after medical treatmentfor a petechial hemorrhagic stroke in the left middle cerebralartery (MCA) distribution. Serology was negative. Echocar-diogram was negative for extracranial carotid disease. Trans-esophageal echocardiogram was notable only for a trivialatrial septal defect. Magnetic resonance imaging (MRI) dem-onstrated MCA intracranial M1 branch of the MCA throm-bosis incompletely as well as multiple periventricular smallvessel and right frontal infarct of chronic nature. His medicalcourse was significant for atrial fibrillation, dysphagia, naso-gastric tube requirements, orthostatic hypotension andhyperglycemia. Comorbidities included diabetes mellitus,coronary artery disease, prior hypertension and history oftransient ischemic accident with right hemiparesis, and left-sided hearing loss.Setting: Acute independent rehabilitation facility.Results: The patient had prestroke neurologic manifesta-tions of peripheral neuropathy and vocal cord paralysis withdysphonia. Initial Functional Independence Measure (FIM)score was 47. He received 3 hours of intense therapy, whichresulted in rapid improvement over a 4-week period. The30-day discharge FIM score was 83, and the patient was ableto be discharged home. His orthostatic hypotension wasresolved with a combination of treatments.Discussion: Neurologic involvement in sarcoidosis typi-cally involves the peripheral systems and is found in only 5%of patients. Stroke presentations are rare despite the cerebro-microvascular pathology associated with neurosarcoidosis.This is an unusual and rare association because most neuro-logic manifestations of sarcoidosis involve the cranial nervesfollowed by meningoencephalitis or intracranial mass le-sions. Neurosarcoidosis may have predisposed the patient toneuropathy contributing to a stroke.Conclusions: Stroke manifestations in patients with neu-rosarcoidosis are rare and require specialized medical reha-bilitation management for the complexities of central andperipheral morbidities.

S196 PRESENTATIONS