Disclosures: Lauren McCormack, BS: No financial relationships or conflicts of interest

Case Diagnosis: A 19-year-old male with a history of brainstem cavernous malformation experiencing acute left foot pain.

Case Description or Program Description: A 19-year-old male with a history of brainstem cavernous malformation requiring suboccipital craniotomy in 2020, complicated by respiratory failure, dysphagia, and right-sided hemiplegia. He spent 4 weeks in a pediatric inpatient rehabilitation unit and was discharged with outpatient therapy and follow-up with a physiatrist. In November 2021, he presented to the clinic with a two-week history of severe, burning pain and decreased sensation to temperature in the left foot. On exam, reflexes were absent in the left lower extremity. A lumbar spine MRI showed a new, hemorrhagic cavernous malformation in the conus region at T12/L1.

Setting: Outpatient Clinical Setting

Assessment/Results: A pediatric neurosurgery referral was made for further evaluation. Surgery was ultimately deferred after considering the potential complication of neurogenic bowel and bladder due to the location of the lesion. Six weeks later, MRI showed mild involution of the lesion. Clinically, the left foot pain and weakness were reduced with neuropathic pain medication.

Discussion (relevance): Cavernous malformations located in the conus are exceedingly rare, accounting for only 0.2% of all cavernous malformations. There are only two previously reported cases of a conus cavernous malformation in a pediatric patient. This presentation is unique, as he presented primarily with sensory, not motor, symptoms. We hope to raise awareness of the role of physiatrists in detecting these lesions.

Conclusions: This case highlights the critical role of physiatrists in assessing new-onset neurologic symptoms. Through collecting a detailed history and performing serial exams, physiatrists can capture significant events, potentially mitigating severe, lifelong neurological deficits. This is especially important in a pediatric population, who may live with these deficits for many years.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/burning-foot-pain-as-presenting-symptom-of-conus-cavernous-malformation-a-case-report/