Disclosures: Andrew F. McElroy, IV, MD: Nothing to disclose

Case Description: Patient presents to tertiary rehab center s/p left total knee replacement. Patient was noted on admission to have macrocephaly and impulsive behavior. During the stay, patient developed an unrelenting headache and both CT and MRI were done both showing significant ventriculomegaly with a large porencephalic cyst greater on the left. The cyst measured 17.08cm by 10.54cm by 10.99cm with complete obliteration of left parietal lobe.

Setting: Rehabilitation unit in a Tertiary Hospital

Patient: 71 F with PMH of porencephalic cyst, fibromyalgia and anxiety.

Assessment/Results: Patient had very impulsive behavior but made good progress in her 5 days in acute rehabilitation. Patients FIM score improved from 78 on admission to 100 on discharge. Patients FIM score for walking improved from 2 on admission to 6 on discharge. She had 5/5 strength in both upper and lower extremities b/l, except for 4/5 strength in left knee extension, which was expected due to recent total knee replacement. No sensory deficits were noted and all reflexes were within normal limits. Cranial nerves were intact, and no visual deficits.

Discussion: Porencephalic cyst is an uncommon intra-cranial cyst in adults. It can be congenital or acquired cavity within the cerebral hemisphere. It contains cerebrospinal fluid and usually communicates directly with the ventricular system. It has been suggested that porencephalic cysts are caused by a disturbance of vascular supply leading to cerebral degeneration. Patients may be asymptomatic or may present with visual field deficits, hemiplegia, cognitive or behavioral changes. Studies must be done to differentiate between stroke and brain tumor.

Conclusion: The review of literature supports porencephalic cysts of different sizes, but this case showed much larger involvement including obliteration of the left parietal lobe. Even with a large decrease in brain mass patient still has no observable residual effects, besides a very impulsive behavior.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/lack-of-residual-effects-in-patient-with-large-porencephalic-cyst-a-case-report/