Louisiana Research Day Program Book 2025

Case Studies: Section 1

Case Studies: Section 1

Bilind Ismail, MD 1 ; Michael Chammany, OMS-IV 2 ; Ahmed Virani, MD 3 1 Willis Knighton Health System, Internal Medicine, Shreveport, LA; 2 VCOM-Louisiana, Monroe, LA; 3. Willis Knighton Health System, Department of Pulmonary and Critical Care, Shreveport, LA 85 VALPROIC ACID-INDUCED ACUTE NECROTIZING PANCREATITIS COMPLICATED BY WERNICKE ENCEPHALOPATHY AND INTRATHALAMIC HEMORRHAGE

Allen Dennis, OMS-II; Noah Bauman, OMS-II; Stephanie Aldret, DO, FAOASM VCOM-Louisiana 84 PERSISTENT NEUROLOGICAL SYMPTOMS FOLLOWING A POSTERIOR ACETABULAR FRACTURE REPAIR

Context/Impact: A collegiate football player sustained a posterior wall acetabular fracture that was repaired with an open reduction and internal fixation (ORIF). While the initial recovery was uneventful, he later developed radicular symptoms that ultimately ended his collegiate career. Case Report: A 21-year-old male Division 1 football safety presented with right hip pain and numbness following an injury during an away game. The injury occurred when his foot was planted while blocking a lineman. He felt a distinct pop in his right hip as he fell to the ground with the lineman’s weight on him. When he was able to get up, he had immediate pain and numbness in his hip but was able to leave the field unassisted. Physical examination revealed groin tenderness and pain with hip flexion and internal rotation. Sideline osteopathic manipulation was ineffective for symptom relief. Pain and muscle stiffness increased with rest on the sideline, requiring crutches for ambulation. Once home, groin tenderness and pain with hip flexion persisted, and he now noted severe pain with internal rotation. Work up revealed a posterior acetabular

wall fracture of the right hip. He underwent ORIF of the posterior acetabular wall fracture, with initial recovery showing good range of motion, strength, and no sciatic symptoms. At three months post-surgery, he reported deep tightness and pain with internal rotation, which was managed with physical therapy. At four months, he was pain-free but reported tightness during forward flexion. Several months later, he presented with new radicular symptoms, including sharp pain radiating down his posterior right leg, and was diagnosed with right lower extremity radiculopathy due to a mild L5-S1 disc protrusion as noted on MRI. Despite treatment with corticosteroids, physical therapy, and neuropathic medications, the symptoms persisted. He was later diagnosed with sciatic nerve compression due to scar tissue, and after months of rehabilitation and modified activities, he remained limited in activity and was disqualified from collegiate football due to his persistent neurological deficits. Comments/Conclusions: Open reduction and internal fixation (ORIF) is a highly effective procedure for acetabular fractures. However, complications such as neurologic symptoms,

as observed in this case, can still occur. These complications can sometimes be debilitating, significantly impacting the patient’s recovery and quality of life. This case underscores the need for further research to reduce the incidence of severe complications and improve recovery times following ORIF for acetabular fractures.

Introduction: Valproic acid (VPA) is widely used to treat various seizure disorders such as epilepsy, though one of its most notable adverse effects is acute pancreatitis. While cases of acute pancreatitis progressing to necrotizing pancreatitis due to administration of VPA are well-documented, instances of Wernicke Encephalopathy arising from thiamine deficiency due to pancreatitis are comparatively rare. In this report, we discuss the case of a young male patient who suffered from a right thalamic intraparenchymal hemorrhage occurring within the setting of Wernicke Encephalopathy secondary to necrotizing pancreatitis. Case Presentation: An 18-year-old male with a history of autism and epilepsy managed with VPA presented to the emergency room one month after the initiation of VPA due to severe abdominal pain. Elevated amylase and lipase levels, along with his clinical symptoms, suggested a likely diagnosis of pancreatitis. Despite initial conservative management, the patient developed necrotizing pancreatitis with large pseudocyst formation likely secondary to his use of VPA, necessitating percutaneous drainage. Following the procedure, the patient

was discharged to a long-term acute care facility, where the percutaneous drain was eventually removed. One week after drain removal, the patient presented to the emergency room from his hepatobiliary surgery clinic due to hypotension and altered mental status with ongoing abdominal pain. A CT of the abdomen and pelvis revealed infected pancreatic pseudocysts that ultimately required admission and three percutaneous drainages. Shortly after the drainages, the patient became septic, was started on antibiotics, and was admitted to the intensive care unit (ICU). The patient’s respiratory function deteriorated while in the ICU, ultimately requiring intubation, and four days after placement in the ICU, the patient became stuporous. A brain CT showed an acute intraparenchymal hemorrhage within the right thalamus extending into the third ventricle, and MRI brain showed severe manifestation of Wernicke Encephalopathy accompanied by hemorrhage likely due to critical illness and nutritional deficiencies secondary to necrotizing pancreatitis. Soon after, the patient developed loss of respiratory drive, absent direct gag and cough reflexes, and unresponsiveness despite being off of all sedatives. Despite some

improvement in spontaneous respiratory effort, the patient remains somnolent and is unlikely to recover baseline neurologic function. Discussion: This case not only illustrates an instance of VPA induced pancreatitis progressing to necrotizing pancreatitis, but also highlights the persistence of the disease despite drainage and the severe nutritional deficiencies that can arise, leading to complications like Wernicke encephalopathy. As Wernicke encephalopathy progresses, the development of intraparenchymal hemorrhage within the thalamus extending to other brain structures is rare yet possible, as demonstrated in this report. This case report emphasizes the importance of early recognition and management of VPA-induced pancreatitis, alongside vigilant monitoring for the severe sequelae that may arise.

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2025 Research Recognition Day