1024 - Alternative Management of Olecranon Bursitis Following Basal Ganglia Hemorrhage: A Case Report

Case Diagnosis: 59-year-old male with right basal ganglia hemorrhage complicated by aseptic olecranon bursitis

Case Description: A 59-year-old male presented to the Emergency Department with left-sided weakness, dysarthria, and a ground-level fall. Diagnostic evaluation revealed an acute intraparenchymal hemorrhage in the right basal ganglia, and he was managed with antihypertensive therapy. The patient was transitioned to acute inpatient rehabilitation, but was subsequently readmitted for treatment of pyelonephritis.  His hospital course was further complicated by a non-traumatic fall resulting in left-sided aseptic olecranon bursitis. Orthopedic evaluation recommended conservative management, and a course of vancomycin was initiated for suspected cellulitis. Infectious disease consultation later switched therapy to a seven-day course of doxycycline. Neither antibiotic trial improved his pain or range of motion. Upon readmission to acute rehabilitation, he was started on diclofenac topical gel three times daily.

Discussions: Four days after initiating diclofenac, the patient reported his first signs of pain relief. By the second week, he demonstrated continued improvement in pain, erythema, and edema, with complete resolution of symptoms after three weeks of treatment. Recovery was monitored through subjective pain ratings, presence of edema and erythema, and active range of motion.
Falls are a frequent cause of adverse events in post-stroke patients and often result in traumatic injuries, prolonging hospitalization and delaying functional recovery. In this case, the fall led to aseptic olecranon bursitis, which posed a management challenge given the contraindication to systemic NSAIDs in the setting of recent intracerebral hemorrhage. The use of a topical NSAID provided an effective alternative, achieving pain control and functional improvement without increasing systemic bleeding risk.

Conclusions: We present a case of aseptic olecranon bursitis, a post-fall complication in a stroke patient, successfully managed with topical NSAID therapy. This case highlights topical diclofenac as an effective alternative first-line option in situations where oral NSAIDs are contraindicated, such as intracerebral hemorrhage.