PM&R
9S, 2014 S215
spontaneous movements and responded to painful stimuli. On the
third day, she was more awake and alert and was transferred to the
general medical floor and was eventually discharged home upon
resolution of symptoms.
Discussion: Patients undergoing rehabilitation tend to be on
several serotonergic agents. This case study highlights the impor-
tance of considering the possibility serotonin syndrome when
patients are on serotonergic agents especially if they have chronic
kidney disease.
Conclusions: One dose of duloxetine in a chronic kidney disease
patient while on trazodone may cause serotonin syndrome.
Poster 92
Persistent Fainting with Nausea and Vomiting:
A Case Report.
Don Mathew (Marianjoy Rehabilitation Hospital,
Wheaton, IL, United States); Padma Srigiriraju, MD.
Disclosures: D. Mathew, No Disclosures: I Have No Relevant
Financial Relationships to Disclose.
Case Description: A 40-year-old woman with depression and
anxiety who worked as an accountant, presented with several
episodes of fainting lasting less than a minute, along with bouts of
nausea and vomiting for over 1 week’s duration. The patient
described these episodes as sporadic and sometimes without
preceding symptoms. Other times, she reported feeling light
headed. These would occur with positional changes, typically from
supine to sit or sit to stand. She also experienced nausea and
vomiting upon eating, which eventually led to unintentional weight
loss and deconditioning. She presented to a University Medical
Center, where she was extensively worked up without any prom-
ising leads. Subsequently, the patient was seen by neurology and
evaluated in an autonomic laboratory. The patient’s findings
appeared to be consistent with seronegative autoimmune subacute
autonomic neuropathy with severe orthostatic hypotension. It
described the process to be at the level of the cardiac vasomotor and
pseudo motor fibers, more so than cardiac vagal fibers. Patient was
then placed on midodrine and fludrocortisone to help alleviate the
orthostatic hypotension along with nutritional supplementation
and Marinol to aid with appetite. She also received a plasma
exchange, with only moderate relief. The patients symptoms per-
sisted and led to difficulty in ambulating, balance issues, and
difficulty transferring. In addition to medical therapy, the patient
was sent to acute inpatient rehabilation.
Setting: Acute Inpatient Rehabilitation Hospital,
Results or Clinical Course: Since her admission in rehabil-
iation, the patient’s hospital course continued to be complicated;
however, there were significant gains acheieved that medical
management alone could not provide. The patient demonstrated
improvements in all aspects of rehab, including strength and
functional mobility. Moreover, she achieved more endurance,
better balance, and independence in managing her own
symptoms.
Conclusions: Innovative techniques, such isometric exercises
to help improve orthostasis and cardiovascular retraining to help
stabilize autonomic dysfunction, in addition to balance and
strength training, are all essential rehabilitation components
which complement medical managment when treating the
complexities of seronegative autoimmune subacute autonomic
neuropathy.
Vol. 6, Iss.
Poster 93
Lipedema, Lymphedema and Lipolymphedema:
A Case Report.
Abir Naguib (Montefiore, Bronx, NY, United States);
Anna M. Lasak, MD.
Disclosures: A. Naguib, No Disclosures: I Have No Relevant
Financial Relationships to Disclose.
Case Description: A 34-year-old woman presented with bilat-
eral lower extremity (BLE) swelling and pain for 3 years. She had
been seen by various practitioners; extensive workup had been
done and she was diagnosed with primary lymphedema. She had
been on diuretics but did not show any improvement. On exami-
nation, there was BLE swelling and erythema of the legs with skin
induration. The swelling was especially prominent from the mid leg
to the ankles. There was non-pitting edema on the dorsum of both
feet. Stemmer’s sign was positive and there was tenderness to
palpation. Limb circumference measurements were done at the
metatarsophalangeal joint, heel, 10cm proximal to the lateral mal-
leolus and at 10 cm increments up to 70 cm from the lateral
malleolus. Body mass index was 55.7 kg/m2 and so weight loss was
encouraged.
Setting: Outpatient rehab clinic.
Results or Clinical Course: Based on the clinical findings, the
patient was diagnosed as lipolymphedema. She underwent
complete decongestive therapy (CDT) which included manual
lymphatic drainage, compression bandaging and compression
stockings. Sessions were 2-3 times a week and each session lasted
90 minutes and so it was decided to initiate therapy on one
extremity at a time. A home exercise program was taught. After 3
months of therapy, there was a significant improvement in the left
LE swelling and pain compared to before and compared to the
right LE.
Discussion: Lipedema is the bilateral symmetrical deposition of
fatty tissues in the lower extremities, extending from the hips to the
ankles, sparing the feet. It is believed to be genetic and hormonal in
origin being almost exclusively limited to females. It is an under-
diagnosed condition as it is commonly mistaken for lymphedema
or obesity and so diagnosis is usually late. It results in decreased
mobility and disfigurement leading to depression and eating
disorders. Lipolymphedema is a complication of lipedema which
involves secondary lymphedema. Thus, early diagnosis and
management of lipedema with CDT is important to prevent
complications.
Conclusions: Although there is no definitive treatment for lipe-
dema, patients may benefit from CDT, diet and exercise. It is
a chronic condition, therefore physiatrists must educate patients on
maintenance therapy and self management in order to prevent
progression.
Poster 94
Bilateral Hip Pain and Limited Functional Recovery in
Guillain Barre Syndrome: A Case Report.
Abir Naguib, (Montefiore, Bronx, NY, United States);
Huma H. Naqvi, MD.
Disclosures: A. Naguib, No Disclosures: I Have No Relevant
Financial Relationships to Disclose.
Case Description: A 47-year-old man presented with acute
onset of bilateral upper and lower extremity numbness and weak-
ness. He reported viral illness a week prior. Muscle strength was 1/5