Disclosures: Bruce Zhang, MD: Nothing to disclose

Case Description: A 55-year-old woman with PMHx ethanol abuse, chronic pancreatitis, and pancreatic pseudocyst presented initially to acute care with liver and splenic abscesses believed to be from pancreatic pseudocyst transformation. While the aforementioned was managed, she subsequently developed a progressive cerebellar syndrome. Thorough investigation was performed including CSF studies, vitamin levels, meningoencephalitis panels, and paraneoplastic panels. All were negative. However, brain imaging revealed cerebellar atrophy. Despite prompt treatment with IV thiamine and IVIG for presumed autoimmune cerebellar syndrome, the patient continued to present significant limb/trunk ataxia, dysphagia and dysarthria requiring dependent care in mobility and ADLs.

Setting: Tertiary Care Rehabilitation Center.

Patient: 55-year-old woman with subacute cerebellar syndrome.

Assessment/Results: The patient was subsequently admitted to acute inpatient rehabilitation to receive intensive multidisciplinary neurorehabilitation. In her routine balance and ADL training, robotic assisted therapy was incorporated to promote neuroplasticity via motor control and sensory feedback. In addition, NMES dysphagia therapy, communication tools, adaptive equipment, and medications were assessed and optimized to improve independence in ADLs. After 40 days of training, she progressed to minimum assistance/close supervision in upper extremity ADLs, and moderate/maximum assistance for her transfers. Significant reduction of caregiver burden was attained, and the patient’s family found this level of support to be safely manageable. She was subsequently discharged home to continue home therapies.

Discussion: We describe a perplexing case of subacute cerebellar syndrome treated with intensive inpatient rehabilitation. Proven pharmacological therapies for ataxia are limited. Primary treatment is based on symptom management and maintenance of function, of which rehabilitation is a crucial component.

Conclusion: This case provides further evidence that multidisciplinary inpatient rehabilitation with balance, coordination, and technology-facilitated gait training is beneficial for patients with debilitating cerebellar ataxia. A comprehensive approach facilitates development of effective treatment strategies to improve function and quality of life for future patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/perplexing-case-of-sub-acute-cerebellar-syndrome-in-the-inpatient-rehabilitation-setting-a-case-report/