Disclosures: Deanna R. Claus, MD: No financial relationships or conflicts of interest

Case Diagnosis: Previously healthy 21-year-old male with new longitudinally extensive transverse myelitis (LETM)

Case Description or Program Description: The patient developed acute back and chest pain, which progressed rapidly to arm numbness, then tetraplegia over the course of 24 hours. He was subsequently diagnosed with LETM after MRI demonstrated cord enhancement from C4 to T1. Exam 10 days after symptom onset was documented as C6 AIS A spinal cord injury. He underwent treatment with steroids, intravenous immunoglobulin, plasmapheresis, and cyclophosphamide for suspected Neuromyelitis Optica Spectrum Disorder. Acute inpatient rehabilitation (AIR) initiated 23 days after symptom onset.

Setting: Tertiary Care Academic Hospital

Assessment/Results: At time of admission and discharge from AIR, Quality Indicators (QI scores) assessed his level of function. He underwent a 28-day AIR stay. On admission, the patient was dependent (QI score of 1) for all self-care and mobility activities of daily living (ADLs) with exception of upper body dressing (3). Discharge QI scores demonstrated improvement in eating (3), oral hygiene (4), ability to shower/bathe self (3), lower body dressing (3), rolling left and right (3), wheeling 50 feet with 2 turns (6), and wheeling 150 feet (6) in a power wheelchair. He remained dependent for 6 out of 12 of testable ADLs. He had no gains in muscle strength testing and International Standards for Neurologic Classification of Spinal Cord Injury (ISNCSCI) classification was unchanged at time of discharge. He discharged to a home environment with family support and home health services.

Discussion (relevance): This patient’s QI scores show limited changes in physical function. While some patients experience neurologic recovery after a diagnosis of LETM, this patient did not make neurologic gains and continued to require assistance with all ADLs after AIR, except for power wheelchair mobility.

Conclusions: QI scores from this patient’s rehabilitation stay suggest that complete spinal cord injuries from LETM may experience limited neurological recovery while in AIR.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/quality-indicators-qi-and-functional-gains-during-inpatient-rehabilitation-for-a-patient-with-longitudinally-extensive-transverse-myelitis-a-case-report/