Louisiana Via Research Day Book 2026

Clinical Research

Clinical Research

109 MARKED VISUAL AND MOTOR IMPROVEMENT FOLLOWING EXTENSIVE POSTERIOR CIRCULATION STROKES IN A PFO PATIENT: A CLINICAL CASE REPORT

110 FACTORS ASSOCIATED WITH EHR-CODED VOICE AND RECURRENT LARYNGEAL NERVE OUTCOMES AFTER THYROIDECTOMY

Arooj Arif BS, MS, OMS-III; Andy Langley, DO 1 VCOM-Louisiana; 2 Willis Knighton Louisiana Family Practice, Shreveport, Louisiana

Vignesh Ravichandran, OMS-II, BBA; Lin Kang, PhD; Jenna M. Dittmar, PhD VCOM-Louisiana

Context: Posterior circulation strokes involving the cerebellum, thalamus, and occipital lobes are associated with considerable morbidity and are often thought to result in permanent neurologic deficits. This case highlights the significant visual and motor improvement in a patient despite extensive cerebrovascular damage. Report of Case: We present the case of a 52-year-old left-handed male, with a history of several ischemic strokes affecting the thalamus, cerebellum, and occipital lobes. His clinical course was complicated by right-sided vision loss, which later improved. An MRI of the brain revealed several infarcts located in the posterior circulation. The patient had considerable neurological deficits, including marked functional restrictions and acute vision loss, and was treated with anticoagulation therapy. At subsequent visits, the patient was noted to have a right arm cerebellar-outflow tremor, resulting in a diagnosis of post-stroke Holmes/Rubral/cerebellar tremor, involving the upper and lower extremities. Despite the severity and extent of infarcts, the patient showed significant improvement following a Deep Brain Stimulation (DBS) surgery, regaining the ability to ambulate and return to his prior physical

activities, such as jiu-jitsu. Full visual recovery was also achieved. The cause of the strokes was concluded to be cardioembolic, following a transesophageal echocardiogram, which revealed a patent foramen ovale. Conclusion: Infarcts in the posterior circulation are often linked to unfavorable long-term neurological results, especially when they affect the cerebellum, thalamus, and occipital lobes. Prior reviews describe posterior circulation ischemic strokes to specifically cause vertigo, visual disturbances, and sensory or motor deficits. In contrast, our patient demonstrated substantial visual recovery and regained independent ambulation. This case highlights the potential for meaningful functional recovery even in patients with extensive posterior circulation infarcts, with DBS, which is used in Parkinson’s disease to improve tremor, rigidity, and gait, appearing to similarly aid our patient’s recovery. Methods: A focused literature review was conducted using PubMed and Google Scholar with search terms including “posterior circulation stroke,” “visual recovery after stroke,” and “deep brain stimulation.

Background: Recurrent laryngeal nerve (RLN) injury is a serious post-operative complication of thyroid and parathyroid procedures, resulting in vocal fold paralysis, dysphagia, dysarthria, and airway compromise. Numerous surgical and anatomical risk factors have been identified; however, the contribution of patient factors and post-operative follow-up affect RLN injury remains unclear. Objective: The aim of this study is to characterize associations between patient and post-thyroidectomy voice outcomes. Methods: We conducted a retrospective cohort study of adult patients that underwent thyroid surgery using electronic health record (EHR) data from the National Institutes of Health All of Us Research Program. The index operation was defined as the most recent thyroid surgery per patient. Individuals with preoperative voice diagnoses within the 365 days preceding the index surgery were excluded, and restricted analyses to patients with complete 180-day follow-up. Outcomes included post-index voice diagnoses and high-specificity RLN codes within 180 days. Multivariable robust Poisson

models were used to estimate adjusted risk ratios (RRs). Covariates included demographic characteristics, reoperation status, surgical proxies, comorbidity burden, calendar year, and non-voice postoperative follow-up intensity as a measure of healthcare utilization. Results: The final cohort included 1,091 patients who completed the necessary medical follow-up. Older age and greater post operative healthcare contact were associated with increased probability of post-index voice diagnosis. Traditional surgical variables, including reoperation, thyroid cancer indication, and Graves’ disease, showed imprecise and non-significant associations, likely due to sparse exposure. Calendar year was positively associated with increased incidence of broadly defined voice diagnoses but not with high specificity RLN codes, suggesting changes in documentation rather than an increase in clinically specific RLN injury. Conclusion: In this EHR-based cohort with full 180-day follow-up, older age and greater non-voice health-care utilization were associated with increased documentation of post

thyroidectomy voice outcomes. Associations for coarse surgical proxies were inconclusive. These findings suggest that biological vulnerability and surveillance may contribute to perceived RLN injury more than operative factors. Future studies integrating laboratory values and standardized post-operative follow-up programs are necessary to improve comparability among differing patient populations.

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2026 Research Recognition Day