Disclosures: David R. Schulze, DO, MS: No financial relationships or conflicts of interest

Case Diagnosis: A newly sustained spinal cord injury which occurred after a fall in the inpatient rehabilitation setting.

Case Description: A 56-year-old male with recent history of vesicular eczema on the hands and feet presented following a ground-level fall, without resultant loss of consciousness or head trauma. Prior to the fall, he had been experiencing 2-3 weeks of progressive generalized weakness, pedal burning sensations, weight loss, and abdominal discomfort. The patient underwent a 10-day broad workup for an expansive differential diagnosis, following which he was admitted to inpatient rehabilitation for generalized weakness of unknown etiology, with plans for a more comprehensive evaluation outpatient. Two days later he sustained another fall, and the following day was noticed to have an acute worsening of strength with new-onset bladder incontinence. An emergent cervical spine MRI revealed significant C4-C6 central stenosis with spinal cord compression, resulting in an urgent neurosurgical consultation with subsequent C3-C6 posterior laminectomy and fusion.

Setting: In-patient RehabAssessment/

Results: This patient had several possible reasons for his progressive weakness, but the swift decline in motor function, paired with new-onset bladder incontinence, encouraged a more targeted workup, which consequently revealed an acute spinal cord injury secondary to severe spinal stenosis.

Discussion: While the goal of inpatient rehabilitation is consistent functional improvements, it is important to note when a patient’s progress stalls or begins to suddenly reverse. A sudden stalling or reversal of progress could indicate something insidious, so it is important to watch for red flag signs or symptoms.

Conclusion: It is vital to always be watchful for new or worsening symptoms on an inpatient rehabilitation unit. Debility may come from one of several sources, but there are a few emergent situations, such as an acute spinal cord injury, where fast action could make a drastic difference in an individual’s functional outcome.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-newly-sustained-spinal-cord-injury-in-the-inpatient-rehabilitation-unit-when-is-worsening-of-function-simply-debility-versus-something-more-emergent/