Session Information
Date: Friday, November 15, 2019
Session Title: Neurological Rehabilitation Case Report
Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 4
Disclosures: Brian G. McInerney, MD: Nothing to disclose
Case Description: 36-year-old female presents status post MVA. Atlanto-occipital dislocation, right hemidiaphragm elevation secondary to phrenic nerve injury, respiratory insufficiency, traumatic brain injury SDH, SAH, gastric perforation, scaphoid fracture, vertebral artery dissection. Patient was brought to the OR immediately for gastric perforation repair prior to occipital cervical fusion C0-C4 with instrumentation. Post OP a PEG tube was placed along with Trach secondary to respiratory failure and inability to spontaneously ventilate. 48 hours post injury physical revealed patient was able to move right great toe 2/5 and blink answers appropriately with no determinable sensation. On admission to acute rehabilitation 1-week post injury; physical showed BL 2/5 toe flexion/extension, BL 2/5 finger flexion/extension and ability to blink answers appropriately with sporadic intact sensation to pinprick and light touch.
Setting: Acute Inpatient Rehabilitation
Patient: 36 y/o Female C1 ASIA C s/p MVA
Assessment/Results: C1 ASIA C on ventilator with Trach collar, C-collar, being fed through PEG. Within the first 2 weeks patient regained at least 3/5 strength in over half of the muscle groups below level of injury progressing to a C1 ASIA D however still max assist. She was weaned off ventilator and regained her ability to verbalize and was decannulated. Over the next 6 weeks she progressed well with therapies PT/OT/SLP with strength, endurance, voice control and ambulation first with DME and finally discharged without.
Discussion: The importance of prognostication in SCI ASIA B vs ASIA C regardless the level of injury or complications and patient potential recovery.
Conclusion: Upholds prognostic data that despite the level of injury a patient with SCI ASIA C has good prognosis to improve to ASIA D approx 67% within the year.
Level of Evidence: Level V
To cite this abstract in AMA style:
McInerney BG. Atlantooccipital Dislocation Recovery C1 ASIA C 1/5 Toe Movement Unilaterally Recovery C1 ASIA D Walking Without DME in 2 Months [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/atlantooccipital-dislocation-recovery-c1-asia-c-1-5-toe-movement-unilaterally-recovery-c1-asia-d-walking-without-dme-in-2-months/. Accessed May 15, 2025.« Back to AAPM&R Annual Assembly 2019
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/atlantooccipital-dislocation-recovery-c1-asia-c-1-5-toe-movement-unilaterally-recovery-c1-asia-d-walking-without-dme-in-2-months/