Disclosures: Daniel A. Sainburg, DO: Nothing to disclose

Case Description: This patient initially presented with right-sided weakness after a fall in July, 2018. CT/MRI (computed tomography/magnetic resonance imaging) brain showed small right temporal Subarachnoid Hemorrhage (SAH), inconsistent with deficits. CT thoracic/lumbar spine was unremarkable. Infectious work-up was initiated and was unrevealing. The patient was started on levetiracetam for presumed seizure with Todd’s paralysis. He was discharged to AIR and subsequently home with symptomatic improvement. He re-presented with right-sided weakness in September 2018 after another fall. Imaging revealed right subdural hematoma (SDH) with mass effect, and he underwent burr hole decompression. He discharged to AIR due to weakness and functional decline. On admission, the patient had significant right-sided weakness and hyperreflexia, again inconsistent with his known right SDH. Further workup was pursued. MRI spine demonstrated multiple cervical and thoracic enhancing lesions concerning for infectious myelitis vs immune reconstitution inflammatory syndrome (IRIS) vs lymphoma. He was discharged home with close Infectious Disease, Neurology and Physiatry follow-up. With ongoing therapies, steroids, and anti-retroviral therapy, his symptoms and functional mobility improved.

Setting: Acute Inpatient Rehabilitation (AIR)

Patient: 29-year-old male with history of HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) recently started on antiretroviral therapy

Assessment/Results: After his falls, the patient presented with right-sided weakness despite right-sided intracranial bleeds. MRI spine later revealed cervical and thoracic enhancing lesions which better explained his overall clinical picture. He was ultimately started on oral steroids. Along with continued antiretroviral treatment and physical and occupational therapies, he made substantial functional and symptomatic gains.

Discussion: This case demonstrated that pathology seen on imaging is not always the cause of the patient’s symptoms. This phenomenon is often described in the pain management setting but to our knowledge has yet to be documented in TBI literature.

Conclusion: It is important to correlate imaging with symptoms and exam findings following brain injuries to determine if further work-up is indicated.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/subarachnoid-hemorrhage-subdural-hematoma-as-a-red-herring-in-a-case-of-hiv-associated-myelitis-a-case-report/