Disclosures: Grant D. Langhofer, DO: No financial relationships or conflicts of interest

Case Diagnosis: Inpatient Rehabilitation of a Spinal Cord Injury Patient With Acute Demyelinating Polyneuropathy

Case Description or Program Description: We present a case of a 54-year-old patient who sustained a T12 ASIA A spinal cord injury following a fall. Three days following admission, he reported new onset peri-oral numbness and difficulty with face and tongue mobility resulting in difficulty swallowing, suggestive of bilateral Bells palsy.

Setting: Inpatient rehabilitation hospital

Assessment/Results: Neurology was consulted. MRI brain was obtained and was negative for acute ischemia. Patient received bolus of IV solumedrol and was started on oral Prednisone. One week after symptoms began, he also experienced bilateral shoulder pain and subjective weakness. Bilateral shoulder x-rays revealed no acute pathology. EMG was obtained and revealed: Moderate-severe sensorimotor polyneuropathy, primarily demyelinating in nature with significantly prolonged F-waves, general slowing of conduction velocities, and prolonged distal latencies. Patient received IVIG x 5 days with relief of symptoms. Patient was discharged to home at independent level following course of IVIG.

Discussion (relevance): The unique clinical course of this patient provides an opportunity to provide better, more timely care for patients with similar symptoms. There is a plethora of studies representing the benefit patients can receive after starting immunotherapy following diagnosis of AIDP. There is limited data; however, addressing identification of AIDP in the SCI population. This case demonstrates the challenges associated with diagnosing AIDP in the SCI population, as it typically presents with ascending paralysis. This case may provide some clinical guidance when presented with a case of acute weakness in the rehabilitation hospital.

Conclusions: Although this patient presented with facial weakness consistent with bilateral Bell’s palsy, his progressive symptoms raised concerns about an alternative diagnosis. Further diagnostic testing revealed a true underlying cause of weakness. The patient’s successful response to immunotherapy reflects the importance of timely diagnosis and treatment of AIDP in a challenging patient population.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/inpatient-rehabilitation-of-a-spinal-cord-injury-patient-with-acute-demyelinating-polyneuropathy/