Disclosures: Alexander Heck, MD: No financial relationships or conflicts of interest

Case Description: Patient was found down and unresponsive for an unknown period of time. Extensive workup including LP, EEG and MRI were non-specific. Brain biopsy revealed Toxic Spongiform Leukoencephalopathy. Patient was in disorder of consciousness (DOC) for over 30 days, with course complicated by multiple organ system failure, sepsis, rhabdomyolysis, frontal CVA. Withdrawal of care was considered. PM&R was consulted to manage his paroxysmal sympathetic hyperactivity and DOC, and patient was admitted to inpatient rehabilitation hospital (IPR). At that time, he remained PEG dependent, tracheostomy capped, could communicate with unreliable head shake/nod, and was wheelchair dependent. He was titrated on amantadine and lisdexamfetamine (on premorbidly), and spasticity was managed with baclofen and botulinum toxin. At the time of discharge, patient’s tracheostomy was decannulated, PEG tube was removed, he was able to ambulate at a supervision level without assistive device. Cumulative FIM scores improved from 11 on admission to 36 on discharge for measured categories.

Setting: Inpatient Rehabilitation Hospital

Patient: A 29-year-old patient with past medical history of ADHD, drug and alcohol abuse. Assessment/

Results: Four months after discharge, patient was driving and was independent with all ADL’s. He remained only on lisdexamfetamine, on a lower dose than had pre-morbidly. Almost 1 year post injury he was working part time and working with BVR on higher level occupational skills.

Discussion: Toxic Spongiform Leukoencephalopathy is a disorder of white matter caused by leukotoxic agents, commonly found as a result of inhaled solvents related to drugs of abuse, with a wide ranging clinical presentation. We present a severe case of toxic spongiform leukoencephalopathy and the resulting rehabilitation considerations, specifically noting functional gains in this patient who remained in DOC for over 30 days and withdrawal of care was considered.

Conclusion: Recovery to the point of independence can be seen in patients with severe Toxic Spongiform Leukoencephalopathy, however it is rare.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/recovery-after-toxic-spongiform-leukoencephalopathy-a-case-report/