S330 PRESENTATIONS

beats/minute), hypotension, and elevated creatinine phosphoki-nase (CPK). Physical examination revealed increased lowerextremity spasticity and left thigh edema with no signs of warmthor rigidity. Panculture was negative. Venous duplex ultrasoundof bilateral lower extremities was negative for deep venousthrombosis. Computed tomography (CT) of the thoracolumbarspine, abdomen, and pelvis were negative for post-surgicalabscess or osteomyelitis. Suspicion for neuroleptic malignantsyndrome prompted discontinuation of olanzapine. Patientcontinued presenting with cyclical fever despite empiric treat-ment with broad-spectrum intravenous antibiotics andibuprofen. Patient was transferred to acute care facility for furtherwork-up where CT thorax showed cavitary lung lesions sug-gesting tuberculosis; sputum was negative thus no treatment wasinitiated. Decreased passive range of motion and hip painprompted MRI of bilateral hips revealing focal myositis. Triple-phase bone scan performed led to diagnosis of heterotopicossification (HO) of bilateral greater trochanters. Followingrepeated and extensive evaluation for infectious causes of fever,HO was postulated to be the etiology.Setting: Inpatient Rehabilitation Unit.Results or Clinical Course: Following initiation of Etidronate600mg 3 times a day, fever and leukocytosis resolved and CPKnormalized in 4 days.Discussion: The hallmark signs and symptoms of HO includewarmth, erythema, edema, pain, and decreased range of motion. Inthis patient, high fever, hypotension, tachycardia and leukocytosissuggested sepsis and repeated evaluations for infection delayeddiagnosis of HO.Conclusions: As fever and leukocytosis may be early signs ofHO, high index of suspicion for HO in spinal cord injury patientswith a sepsis-like presentation is essential for a timely interventionand favorable patient outcome.

Poster 413New-Onset Restless Leg Syndrome Secondary to LeftMCA Territory Stroke: A Case Report.Amber L. Graham, MD (University of Virginia, Charlot-tesville, VA, United States); Paul T. Diamond, MD.

Disclosures: A. L. Graham, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: An 87-year-old woman presented withdense right hemiplegia and immediate onset of left lowerextremity pain. Brain MRI revealed an acute infarct in thedistribution of the mid anterior left MCA. MRA was unremark-able. The patient was referred for acute inpatient rehabilitationbut course was complicated by persistent nonspecific pain in theleft lower extremity. Because patient had sustained a ground levelfall at the time of her stroke, there was a concern for occultfracture or other soft tissue injury. Studies included plain films,lower extremity MRI, lower extremity Doppler, and LS spinefilms, all of which were negative. She had no response to trials ofvarious pain medications. The location of her pain variedthroughout the entire extremity and she incessantly moved herleg in a fashion resembling post-stroke dystonia, flexing at thehip and knee. However, she was able to control these movementsvoluntarily. Given the nonspecific nature of her complaints and

the patient’s insistence on moving the limb in an attempt torelieve the discomfort, a trial of ropinirole for possible restlessleg syndrome was initiated with significant resolution of hersymptoms.Setting: Acute Rehabilitation Hospital.Results or Clinical Course: After initiation and titration ofropinirole to 0.5 mg daily, the patient had resolution of her lowerextremity pain and was able to more fully participate and progressin her rehabilitation program.Discussion: Pain is common in the post-stroke rehabilitationsetting and can negatively impact participation, funtional recovery,and quality of life. The differential diagnosis is broad and effectivetreatment requires a specific diagnosis. The new-onset of restless legsyndrome is extremely rare in the setting of ischemic cortical stroke.However, in the case under review, it was the primary cause of thepatient’s post-stroke pain and was highly responsive to pharma-cologic therapy.Conclusions: New-onset restless leg syndrome should beconsidered in the differential diagnosis of lower extremity pain inthe immediate and post-acute period following ischemic stroke.

Poster 414Variability of Bioactive PAC (Proanthocyanidins)Among Cranberry Extracts and the Efficacious Dosefor the Reduction and Prevention of UTIs.Bilal Chugtai, MD (Weill Cornell Medical Center, NewYork, NY, United States); Amy Howell, PhD;Chrissy Warren, MS.

Disclosures: B. Chugtai, Other: Trophikos, LLCObjective: Review elements identified in scientifiic literature thatdefine an efficacious cranberry product including dosing, stan-dardization and measurement method. Examine the variability andbioactivity in 7 cranberry products.Design: Seven cranberry products were tested for bacterial anti-adhesion activity using a hemaglutination assay specifc for P-fimbriated Escherichia coli. PACs were isolated using the gravimetrictechnique (C-18 followed by Sephadex LH-20 solid phase chro-matography) to determine levels in each product and tested for anti-adhesion activity on an equal weight basis (starting concentrationof 5 mg/mL).Setting: University Research Center.Interventions: Fluorescence microscopy of E.coli gfp þ straincultured in urines of volunteers collected after cranberry powderconsumption and loaded on T24 epithelial cells.Main Outcome Measures: Anti-adhesion activity and PAC(proanthocyanidin) content.Results or Clinical Course: Anti-adhesion activity rangedfrom 0.47 to 60 mg/mL. Anti-adhesion activity for four of theproducts was not able to be detected. PAC levels ranged from0.56 to 175 mg/g.Conclusions: There is a large amount of variability in theamount and bioactivity of PACs in commercially availablecranberry products. In addition, the ex-vivo epithelial celladhesion assay results indicated a highly significant reductionin bacterial adhesion to T24 cells compared to placebo fol-lowing the consumption of cranberry dosages containing36mg PAC.