Case Diagnosis: The patient is a 62 year old previously independent woman with a history of bicuspid aortic valve status post commissurotomy and ascending aortic aneurysm who developed profound upper extremity paresis and visual and cognitive deficits after undergoing elective aortic valve replacement and aortic aneurysm repair.
Computed tomography of the head and cervical spine were unrevealing and she was transferred to acute rehabilitation. Physical exam revealed profound bilateral left worse than right arm weakness, full leg strength, positive Hoffman and upgoing Babinski signs bilaterally. Brain magnetic resonance imaging (MRI) revealed multifocal subacute infarcts in the right greater than left frontoparietal and bilateral occipital regions. Electrodiagnostic studies (EDX) of the left arm revealed acute left brachial plexopathy involving all trunks. The patient’s rehabilitation regimen was subsequently amended. The patient underwent comprehensive acute inpatient and subsequent outpatient stroke and cardiac rehabilitation. Repeat EDX five months later revealed nearly normal EDX. Patient made significant functional improvements.
Mina Shenouda– PM&R Resident Physician PGY3, JFK-Johnson Rehabilitation Institute
Steven Markos– Chief Resident Physician, PGY4, JFK-Johnson Rehabilitation Institute
Iqbal Jafri– Attending Physician, Director Cardiopulmonary Rehabilitation, Assistant Director Pain Management, JFK-Johnson Rehabilitation Institute
Anthony Doss– PM&R Physician, JFK-Johnson Rehabilitation Institute
David Brown– Attending Physician; Outpatient Medical Director and Director of the Electrodiagnostic Laboratory, JFK-Johnson Rehabilitation Institute
Sara Cuccurullo– Chair, Professor, Residency Director, 1996