Disclosures: Alexander Brahmsteadt, DO: No financial relationships or conflicts of interest

Case Diagnosis: Hydrocephalus secondary to iatrogenic subarachnoid and intra-ventricular hemorrhage

Case Description: A 65-year-old female with past medical history of left retinal artery occlusion and known dural fistula who was admitted to the neuro-ICU following development of subarachnoid and intraventricular hemorrhage with associated hydrocephalus, which occurred during planned proceduralization of prior retinal artery occlusion. She subsequently required intubation and placement of an EVD and VP shunt. Following stabilization, she was transferred to inpatient rehabilitation for a three-week admission and was discharged home to her husband’s care with significant cognitive and functional gains.

Setting: Neurocritical care and inpatient rehabilitation units in a tertiary care referral center.

Assessment/Results: The presence of the same PM&R resident on the primary team during this patient’s neuro-ICU and inpatient rehabilitation admissions objectively improved her clinical course and outcomes in the following ways: expanded knowledge of her acute course while managing her IPR stay; earlier implementation of rehabilitation-based interventions regarding medications, bowel, bladder, and cognitive stimulation among others; enhanced communication between neurosurgical, neurocritical care, and rehabilitation teams during both her ICU and IPR courses.

Discussion: For this patient, the same PM&R resident was on the primary team during both her ICU and inpatient rehabilitation admissions. This is one of several such cases which have occurred at our institution since PM&R residents have begun to pursue neurocritical care training. The purpose of this case report is to illustrate the undeniable benefit of PM&R resident involvement in the neuro-ICU, particularly at institutions where the same resident is able to participate in their inpatient rehabilitation course and eventually, discharge.

Conclusion: Patient outcomes are objectively improved by the presence of PM&R in the neurocritical care unit as a member of the primary team.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-evaluation-of-the-impact-of-pmrs-primary-involvement-within-the-neuro-icu-on-patient-care-and-outcomes-a-case-report/