Disclosures: Filip Cheng, DO: Nothing to disclose

Case Description: The patient presented with acute onset of confusion, aphasia and right hemiparesis. MRI brain revealed new left hemispheric lacunar infarctions and an interval increase in bihemispheric leptomeningeal enhancement. Following extensive yet unrevealing neurological and cerebrovascular workup, the patient was discharged from Stroke service and transferred to the inpatient rehabilitation unit. Given the patient’s numerous strokes of elusive etiology, PM&R enlisted the help of Hematology for further assistance. Brain biopsy results were consistent with Kappa light chain monoclonal gammopathy, a finding typically seen in conjunction with a systemic process. However, fat and bone marrow biopsies found no evidence for a systemic proliferative disorder.

Setting: Acute inpatient rehabilitation unit in a tertiary care hospital.

Patient: A 67-year-old woman with history of recurrent cryptogenic strokes.

Assessment/Results: The patient’s rehabilitation course was notable for unusual symptoms that included profound postural instability and manifestations of psychosis. Due to her poor carryover and limited gains, she was discharged to subacute rehabilitation. Medical workup and caregiver training were completed prior to her discharge. The patient now resides with her sister and continues follow with Hematology and Neurology.

Discussion: Light chain deposition disease (LCDD) is a nonamyloid monoclonal gammopathy, characterized by the deposition of misfolded proteins leading to systemic end organ damage. While rare cases of CNS involvement are known to exist, these have almost always been associated with a systemic lymphoproliferative disorder. In our literature review, there have been fewer than 10 previously reported cases of LCDD restricted to the brain.

Conclusion: This is the first reported case, to our knowledge, of primary CNS light chain deposition disease (LCDD) presenting with recurrent ischemic strokes and undergoing acute inpatient rehabilitation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rehabilitation-of-a-patient-with-recurrent-strokes-due-to-rare-primary-cns-light-chain-deposition-disease-a-case-presentation/