factors might correlate with proximity of the VA to needle locationin a cervical transforaminal epidural steroid injection (CTFESI).Design: Retrospective review.Setting: University hospital.Participants: 198 consecutive patients who underwent a CT an-giogram of the neck at a university hospital.Interventions: Not applicable.Main Outcome Measures: A neuroradiologist documentedVA location in relation to the neural foramen on axial views of CTangiograms. All cervical levels were evaluated but focus was placedon commonly injected levels of C4-7. The VA is not in the neuralforamen at C7-T1 and this level was not evaluated. The distance wasmeasured from VA to ideal needle location for a CTFESI. Other datawere collected including severity of foraminal stenosis, loss of discheight, medical history and demographic data. Analysis was done tosee if any factor correlated with VA proximity to the ideal needlelocation with CTFESIs.Results: The VA was located in the posterior foramen in 27% ofpatients in at least one level from C4-7. The VA was within 2mm ofideal needle location in 26% of patients in at least one level from C4-7.Severity of foraminal stenosis correlated with the VA being located incloser proximity to typical needle location (P�.0001).Conclusions: The VA can sometimes be in close proximity to thetypical target location of a CTFESI. This proximity correlates withthe severity of foraminal stenosis. The interventionalist should bemindful of this and consider looking at the T2 axial MRI beforedoing CFTESIs.

Poster 422Ultrasound-Guided Neurolysis for the Treatment ofIntractable Trigeminal Neuralgia: A Case Report.William Newell, MD (LAGS Spine and Sportscare, SantaMaria, CA, United States); Ake Evans, MD; Jeremiah Ladd,MD; Francis P. Lagattuta, MD; David Majors; Wes Wiltse, DO.

Disclosures: W. Newell, No Disclosures.Case Description: Patient presented on 3/8/2011 complainingof lip pain for many months after being struck in the face whileincarcerated. On examination, his pain was found to correspondwith the sensory distribution of the right trigeminal nerve. Afterundergoing an MRI to rule out a soft tissue mass impinging on thenerve, ultrasound-guided trigeminal nerve injections with dexa-methasone, lidocaine and bupivacaine were performed on 3/30/2011 and 4/13/2011 with excellent pain relief lasting only a fewhours. The patient underwent radiofrequency neurolysis of thetrigeminal nerve on 6/1/2011 and again on 2/9/2011.Program Description: A 52-year-old man with intractable tri-geminal neuralgia.Setting: Ambulatory surgery center.Results or Clinical Course: At 1 week, 5 weeks and 9 weekspost-injection, the patient had a decrease of �50% in his VAS painscore and a substantial decrease in his need for analgesic medica-tion. He experiences numbness in the distribution of the trigeminalnerve but feels it is very preferable to the pain he was previouslyexperiencing. On 2/9/2011 the patient underwent a repeat neurol-ysis after the return of his painful symptoms.Discussion: This patient has experienced significant pain reliefwith radiofrequency ablation of his trigeminal nerve. He also expe-rienced a substantial reduction in his need for pain medication.Conclusions: Ultrasound-guided radiofrequency ablation of the tri-

geminal nerve may be a safe and effective treatment for intractable trigem-inal neuralgia.

PEDIATRICS

Poster 423The Efficacy of Early Use of Intrathecal BaclofenAfter Anoxic Brain Injury: A Case Series Report.Amy H. Ng, MD (BHCS/OCH, Dallas, TX, United States);Frank E. McDonald, MD; Rajashree Srinivasan, MD.

Disclosures: A. H. Ng, No Disclosures.Case Description: 5 children ranging from 18 months to 6 yearsof age with anoxic brain injury (ABI). Case 1 is a 19-month-old boywith ABI due to near drowning with intrathecal baclofen (ITB) pumpplacement less than 3 months after injury. Case 2 is a 2-year-old boywith ABI due to RSV-related respiratory failure with ITB pump place-ment less than 2 months after injury. Case 3 is a 6-year-old boy withABI due to near drowning with ITB pump placement less than 5months after injury. Case 4 is an 18-month-old boy with ABI due tonear drowning with ITB pump placement less than 3 months afterinjury. Case 5 is a 3-year-old boy with ABI due to asphyxia from a grapewith ITB pump placement less than 5 months after injury.Program Description: Case series describing 5 children: 19month, 2 year, 6 year, 18 month and 3 years old who suffered ABIand were treated for spasticity.Setting: Inpatient rehabilitation in a pediatric specialty hospital.Results or Clinical Course: After the baclofen trial, all 5 patientsshowed a reduction of at least one to two points on the Modified Ashworthand Ashworth score. ITB pump placement occurred less than 6 monthspost injury in our case series. All five patients demonstrated improvementin spasticity and tone. Therapists and caregivers noted improvements intone, positioning and sleep and in ease of care in hygiene.Discussion: ITB is not currently indicated as a treatment for reduc-tion in spasticity in children less than 1 year of injury. In this case series,we highlight cases where ITB pumps were placed and used as a safe andalternative treatment to help reduce spasticity and tone less than 6months out from the date of injury. There has been no complications todate. In one case, consideration of pump removal is pending based onimprovement demonstrated after pump placement.Conclusions: ITB is a safe alternative method to reduce spasticityand tone for pediatric patients suffering anoxic brain injury less than 1year out from the date of injury. In addition, this case series highlightsin particular populations less than 6 months out from the date of injury.

Poster 424Neurodegeneration with Brain Iron AccumulationType 1 (NBIA-1): A Case Report.Anupama Kurra, MD (Montefiore Medical Center, Asto-ria, NY, United States); Rani C. Kathirithamby, MD.

Disclosures: A. Kurra, No Disclosures.Case Description: A 12-year-old girl initially presented with in-creasing difficulty walking and abnormal posturing of the left arm. Herworkup included MRI which revealed abnormally high signal in bilat-eral globi pallidi, known as �eye of the tiger� sign. Genetic workuprevealed PANK(�) abnormality, which confirmed diagnosis. Patienthas been managed supportively, with Sinemet for dystonia involvingneck and all 4 extremities, the left arm being the most involved.Setting: Movement disorders outpatient clinic.

S335PM&R Vol. 4, Iss. 10S, 2012