Poster 214: Shy-Drager Syndrome and Ramsay Hunt Syndrome: A Case Report

Abstract

Setting: Acute inpatient rehabilitation unit. Patient: A 35-year-old man with a medical history of Parkinson disease, Shy-Drager syndrome, Ramsay Hunt syndrome, and bipolar disorder, who presented to the acute inpatient rehabilitation unit after multiple falls at home. Case Description: The patient noted inability to use his wheelchair, increasing weakness on his right side, and general functional decline. On the rehabilitation unit, the patient experienced frequent drop attacks as a result of orthostatic hypotension. These drop attacks necessitated multiple interventions, including a helmet for safety, compression stockings, small but frequent meals, and increased assistance/supervision for transfers. The patient responded to physical and occupational therapy and was able to return home independently. Assessment/Results: The hallmark of Shy-Drager syndrome is progressive autonomic failure manifested primarily as orthostatic hypotension. A rehabilitation protocol for a patient with Shy-Drager syndrome, and more generally, orthostatic hypotension, should include: maintenance of adequate blood volume with fluid intake of 2 to 2.5L/d, sleeping in a semi-recumbent position, and rising slowly to standing. In addition, patients should avoid excessive warmth, do moderate rather than vigorous exercise, eat small, frequent meals, and avoid vasodilators such as alcohol and nitroglycerin. Mechanical support may be provided by Jobst's stockings in combination with abdominal binding. Drug therapy may be required when nonpharmaceutical interventions fail. Conclusions: This case describes a previously unpublished combination of Shy-Drager syndrome and Ramsay Hunt syndrome, and the unique challenges posed in the rehabilitation setting.