Virginia Via Research Day Book 2026

Medical Student Research Case Reports

23 FROM CONDITIONING TO THE ICU: A CASE REPORT OF A RARE FORM OF GUILLAIN-BARRE SYNDROME

Michael Stoneham, OMS-II; Kyle Hopkins, DO, PGY4; Jen Walker, MS, LAT, ATC; Anne Bryan, MS, LAT, ATC, CES; Mary Mitchell, DO, CAQSM; Matthew Chung, DO, CAQSM, R-MSK, FAOASM. Corresponding author: mstoneham@vt.vcom.edu

Virginia Tech Sports Medicine, Blacksburg, VA

blanket. EKG showed sinus tachycardia. She was then transported to the ER by private vehicle due to concern for significant cardiorespiratory or neurologic pathology. Labs remarkable for mild AKI, leukocytosis, low TSH, high free T4, elevated ESR, hypoxia on ABG, high glucose, and normal protein on CSF analysis. CT head, MRI C-spine and brain, and EEG were all unremarkable. Due to hypoxia, the athlete was admitted to the ICU. Neurology evaluated and given concern for GBS due to progressive ascending paralysis, initiated IVIG prior to transfer to tertiary care center. Comments: Some neurologic disorders readily fall directly into one diagnosis or another. Functional neurologic disorder (FND, formerly conversion disorder) is a neuropsychiatric condition characterized by symptoms that affect sensory or motor function but are inconsistent with patterns of known neurologic diseases. FND is thought to contribute to 10-30% of neurology specialist visits. Previously a diagnosis of exclusion, but now can be viewed as more rule-in. Several subtypes including motor (weakness/movement disorders) and seizure-type, but many other subtypes and specific situations can cross subtypes. No single test is diagnostic but entails clinical history and exam, and sometimes electroencephalography (EEG) or electromyography (EMG). Lumbar punctures would be

expected to be normal for FND. Approximately 15% of patients hospitalized for FND require intubation. Patients with FND often are stigmatized due to the lack of definitive cause. Diagnosis: Functional Neurologic Syndrome Treatment: Following transfer to tertiary care center in Charlotte, the athlete underwent additional evaluation. Unfortunately, she did require intubation for approximately 24 hours due to worsening hypoxia and concern for respiratory failure. Following extubation and five days of IVIG, plasmapheresis was initiated. The diagnosis remains in question, as myasthenia gravis was also a primary consideration; however, AMSAN subtype was determined to be the most likely diagnosis. She was able to be discharged to skilled nursing facility with plans for rehab for at least three weeks. There has remained no single clear trigger for her presentation, and thus, it is suspected that several factors were likely involved. The athlete was transferred to tertiary care center in Charlotte for further evaluation. She required intubation for approximately 24 hours due to worsening hypoxia and concern for respiratory failure. Developed further neurologic symptoms with radicular nerve pain,

Context: Medicine can require quick responses and clinical gestalt. Here, we outline a case of functional neurologic disorder (FND) in a college athlete. Report of Case: Our athlete is an 18-year-old female collegiate lacrosse player who presented with acute onset paresthesias and presyncope during a conditioning session. At the beginning of the practice, she appreciated a cold sensation first in her feet, then later in her hands. Given the concurrent cold front, she pushed through the practice. Over the course of practice, the sensation progressed to full paresthesias, and she also developed dizziness and dyspnea. She was then found by teammates and onsite ATC, having experienced a pre-syncopal event. She was then transported to the athletic training room. She reported a past medical history of hypothyroidism on levothyroxine, with recent dose change two weeks prior due to fatigue symptoms. Additionally, she was undergoing treatment with albuterol for an upper respiratory illness and suspected mild asthma exacerbation. She was normothermic, normotensive, tachycardic, and tachypneic on vitals. On physical exam, she had complete paresthesia to the bilateral lower extremities with decreased sensation in the bilateral upper extremities. Profound weakness with fine motor strength. She was alert although somnolent and visibly shivering despite multiple layers and

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60 Edward Via College of Osteopathic Medicine (VCOM)