Disclosures: Najaah Hussain, MD: No financial relationships or conflicts of interest

Case Description: A 41-year-old man with acquired immune deficiency syndrome (AIDS), non-compliant with anti-retroviral therapy (CD4 count 81) presented to acute care with one month of progressive bilateral lower extremity weakness and bladder incontinence. Magnetic resonance imaging of the spine revealed diffuse T2 hyperintensity involving both the gray and white matter extending from the cervicomedullary junction to the conus medullaris. Thorough laboratory investigations including a paraneoplastic panel, cerebrospinal fluid studies, and viral serology were otherwise unremarkable. He was eventually diagnosed with AIDS-associated vacuolar myelopathy (VM).

Setting: Tertiary care rehabilitation center

Patient: 41-year-old man develops tetraparesis Assessment/

Results: The patient was subsequently admitted to acute inpatient rehabilitation. He was re-started on highly active antiretroviral therapy (HAART). His physical exam initially showed weakness most prominent in the lower extremities with trace hip flexion and knee extension bilaterally. Initially, he was unable to tolerate ambulation, requiring total assistance with activities of daily living and transfers. After participating in 41 days of intensive inpatient rehabilitation with consistent locomotor training, he was able to functionally ambulate with a rolling walker and was discharged home at a supervision level. Regarding the patient’s urinary incontinence, he was admitted with an indwelling catheter. He was given multiple voiding trials during his stay and was started on an anticholinergic agent and an alpha-blocker. He was able to achieve continence prior to discharge.

Discussion: With the development of effective HAART regimens, AIDS-associated VM is becoming a relatively rare phenomenon. Evidence-based therapies for recovery from disability due to AIDS-associated VM is not yet established. In this patient’s case, an intensive acute inpatient rehabilitation regimen in conjunction with HAART initiation resulted in substantial functional improvement with eventual discharge to home. Furthermore, urinary continence was achievable with a comprehensive bladder program.

Conclusion: An acute inpatient neurorehabilitation program for patients with AIDS-associated VM can yield substantial functional benefits in conjunction with HAART therapy.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-unusual-cause-of-tetraparesis-a-case-report/