Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Hamza Mehmood, OMS-III; Mohammed Almosa, OMS-III; Ishrar Shaid, OMS-III VCOM-Louisiana 47 SPINAL INFARCTION WITH COMPLETE PARAPLEGIA FOLLOWING MECHANICAL AORTIC VALVE REPLACEMENT COMPLICATED BY CARDIOGENIC SHOCK: A CASE OF MEANINGFUL RECOVERY

Hunter Caraway, OMS-III, Stephanie Aldret, DO VCOM-Louisiana; 2 Department of Sports Medicine, North Oaks Health System, Hammond, Louisiana 48 MEDIAL ELBOW ECCHYMOSIS REVEALING AN ISOLATED BRACHIALIS MUSCLE TEAR IN AN ADOLESCENT FOOTBALL PLAYER

Background: Spinal cord infarction is a very well documented complication of thoracic/ thoracoabdominal aortic surgery, but its occurrence post-operatively after aortic valve replacement is exceptionally rare according to current literature. We present a case of complete paraplegia with bowel incontinence and bladder dysfunction following open St. Jude’s aortic valve replacement, with documented partial motor recovery during rehabilitation treatment. A 35 year old female with past medical history significant for hypertension, hypercholesterolemia, type 2 diabetes mellitus, and heart failure with improved ejection fraction, underwent open St. Jude’s mechanical aortic valve replacement. Her perioperative course was complicated by cardiogenic shock with severe hypotension. A few days after extubation, the patient had exhibited symptoms of diminished motor activity as well as decreased sensation in the lower extremities. Spinal imaging performed after hospital discharge demonstrated findings consistent with lower thoracic spinal cord infarction. Neurologic examination revealed complete motor paralysis of the bilateral lower extremities, consistent with ASIA Impairment Scale A. Her recovery course following discharge

was complicated by neurogenic bowel requiring colostomy, and neurogenic bladder that was managed with a suprapubic catheter. The patient was managed with physical therapy during her hospital stay, after discharge, and even currently, and she is slowly regaining motor function in bilateral lower extremities. At a 2 month follow up, the patient reports muscle weakness and sensory loss, but an improvement since hospitalization, progressing from 0/5 on the MRC muscle grading scale to 2/5 of the bilateral proximal lower extremities. The improvement in her motor function signifies progression from ASIA A to ASIA C. She continues to require use of suprapubic catheter, and has a left lower quadrant colostomy placed due to significant bowel incontinence. This case highlights a rare complication in an open mechanical aortic valve replacement, and highlights the potential for neurologic recovery even after a severe spinal cord infarction with initial ASIA A classification. The combination of paraplegia, neurogenic bowel requiring surgical intervention, and documented progression from ASIA A to ASIA C demonstrates valuable prognostic information for counseling patients about recovery potential. Heightened awareness of this rare complication

may facilitate earlier diagnosis, prompt initiation of rehabilitation, and optimization of spinal cord perfusion strategies in future cases.

Context: Isolated brachialis muscle tears are rare, particularly in pediatric athletes, and may be overlooked in the evaluation of acute anterior elbow pain. This case highlights an uncommon sports-related presentation in an adolescent contact-sport athlete and emphasizes the importance of imaging for accurate diagnosis when initial evaluation suggests more common pathology. Report of Case: A 14-year-old Caucasian male American football player presented with right anterior elbow pain and extensive medial ecchymosis six days after falling on an outstretched arm while making a tackle. He denied numbness or tingling. Examination revealed severe medial elbow ecchymosis with swelling, mild tenderness over the medial and anterior elbow, preserved range of motion, and pain with resisted pronation, supination, and long-finger extension. Radiographs were unremarkable. Magnetic resonance imaging demonstrated an isolated partial tear of the brachialis muscle with surrounding intramuscular edema and no adjacent soft tissue or bony injury. The patient was started on conservative management, including

compression, ice, elevation, NSAIDs as needed, activity modification, and physical therapy, with biweekly follow-up planned to guide progression of rehabilitation and return to-play. Conclusions: Review of the existing literature, including prior adult and limited pediatric case reports, demonstrates that isolated brachialis injuries are uncommon and typically associated with hyperextension or eccentric overload mechanisms. Unlike most reported cases, which predominantly involve adults or non-contact mechanisms, this injury occurred in an adolescent during contact sports participation. Previous reports by Van den Berghe, Costa, Forsythe, and others describe successful nonoperative management with full recovery. Similar to these cases, MRI was essential for diagnosis after negative radiographs, and conservative treatment was appropriate. Consistent with prior reports, gradual return to non-contact activity is anticipated within 8-12 weeks, with full recovery by six months. This case expands the narrow pediatric literature and supports consideration of isolated brachialis injury in

adolescents with similar presentation, further guiding appropriate imaging, management, and return-to-play decisions.

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2026 Research Recognition Day