PM&R Vol. 5, Iss. 9S, 2013 S279

report underscores the importance of investigating alternate etiol-ogies in properly diagnosing patients with hypermobility whopresent with atypical seizure-like activity.

Poster 404Acute In-Patient Rehabilitation of an Individual withRare Intradural Cavernous Lymphangioma CausingThoracic Myelopathy: A Case Report.Abhishek Reddy, DO (Marianjoy Rehabilitation Hospital,Wheaton, IL, United States); Dennis Keane, MD.

Disclosures: A. Reddy, No Disclosures: I Have Nothing ToDisclose.Case Description: Patient was an 83-year-old woman withthoracic myelopathy due to recurrent thoracic intradural cavernouslymphangioma. Patient had initial presentation of progressive gaitataxia and weakness in her lower extremities. MRI revealed a cysticstructure found inside the thecal sac with compression of spinalcord. Patient underwent resection of cystic lesion in May 2012 withimprovement in her symptoms thereafter. Pathology reportconfirmed an intradural cavernous lymphangioma. Approximately4 months later, symptoms began to worsen with imaging revealingrecurrence of lymphangioma in proximity of the original site. Thepatient underwent a second surgical intervention with T4-T9laminectomies and resection in September 2012. She was thentransferred to acute in-patient rehabilitation unit for functionalupgrading of severe ataxia and neurogenic bladder. Shortly afterthis rehabilitation course, patient had a third recurrence of the cyst,requiring cysto-peritoneal shunting and subsequent re-enrollmentin acute inpatient rehabilitation finally resulting in stabilization andmild improvement in her symptoms.Setting: Acute In-patient rehabilitation unit in a communityhospital.Results or Clinical Course: With each of the three presenta-tions, patient was noted to have moderate paresis and significantsensory impairments, specifically with proprioception, sensation tolight touch, and pinprick in lower extremities, resulting in severegait ataxia. Other barriers to rehabilitation included neurogenicbowl/bladder and neuropathic pain. All symptoms returned withina few months with surgical resection, ultimately requiring cysto-peritoneal shunting which resulted in stabilization and improve-ment of impairments.Discussion: Only a few cases of lymphangioma of the spine havebeen reported. This is the first reported case, to our knowledge, ofa patient with intradural cavernous lymphangioma in an acute in-patient rehabilitation setting.Conclusions: Intradural lymphangioma requires close clinicalfollow up for recurrence. If not responsive to surgical resection,a combination of cysto-peritoneal shunting and acute inpatientrehabilitation may result in improved functional status.

Poster 405Akinetic Mutism after Anoxic Brain Injury: A CaseReport.Yan Liu (New Jersey Medical School, Newark, NJ,United States); Radhika K. Bapineedu, MD, MBBS.

Disclosures: Y. Liu, No Disclosures: I Have Nothing To Disclose.Case Description: Patient is a 38-year-old woman with historyof hypothyroidism and asthma, presented with shortness of breathand collapsed at home. She was in cardiac arrest for approximately

ten minutes. Initial CT scan of the head was negative, but it was feltthat patient had sustained an anoxic brain injury during theresuscitation process. Upon transferring to rehabilitation facility,patient was noted to be non-verbal, unable to follow commands,and without eye tracking or movement of extremities. However, shedid demonstrate reflexive movements at times. Clinical signs wereconsistent with the diagnosis of akinetic mutism.Program Description: A 38-year-old woman with akineticmutism after anoxic brain injury.Setting: Inpatient Acute Rehabilitation Hospital.Results or Clinical Course: Patient was admitted on neuro-stimulants, Sinemet and Ritalin. Initial orientation log scores wereconsistently under 12 for the first two weeks. On day seven post-admission, a trial of magnesium sulfate was started. Patient received500mg of intravenous magnesium sulfate for a total of nine dosesover the period of five days, and was noted to have markedimprovement in orientation score to the 20’s within one week ofinitiating therapy. Functional Independence Measure score alsoshowed significant improvement after treatment.Discussion: Akinetic mutism is characterized by marked reduc-tion of all motor functions, including facial expression, gestures,and speech output, but with some degree of alertness. The path-ophysiology of akinetic mutism is believed to involve the meso-cortical dopaminergic system, with potential treatment options withdopamine agonists, while others believe that it is related to frontallobe damage and thalamic disconnection. Magnesium is thought tohave neuroprotective effect in post anoxic events, by inhibiting thewaves of cortical spreading depression, which subsequently affectoxygen metabolism, cortical blood flow and cellular changes.Conclusions: Differentiating akinetic mutism from other disor-ders of consciousness is difficult, but very important, as the treat-ment options are entirely different, which may include dopamineagonists, as well as intravenous magnesium sulfate.

Poster 406A Case of Progressive MultifocalLeukoencephalopathy due to HIV/AIDS withFunctional Improvement After Acute InpatientRehabilitation.Ryan Mattie, BA (University of Miami, Miami, FL, UnitedStates); Zack McCormick, MD; Leslie Rydberg, MD.

Disclosures: R. Mattie, No Disclosures: I Have Nothing ToDisclose.Case Description: A 37-year-old man with HIV, presented toclinic for rehabilitation of left hemiplegia and functional impair-ment due to Progressive Multifocal Leukoencephalopathy (PML).Physical exam demonstrated cognitive slowing, dysarthria, left facialweakness, and 0/5 left upper and lower extremity strength withshoulder and elbow contractures. Strength in the right upper andlower extremity was 4-/5 to 4þ/5 throughout all muscle groupsexcept 3/5 for ankle dorsiflexion. There was also right-sided finger-to-nose dysmetria.Setting: Acute Inpatient Rehabilitation.Results or Clinical Course: The patient proceeded throughsuccessful courses of rehabilitation in physical therapy, occupa-tional therapy, speech therapy, and art and music therapy, withFIM scores increasing from 0-1 for functional mobility and ADLs to2-5 upon discharge. In conjunction with the rehabilitative thera-pies, the patient was also treated medically and orthopedically. In