Disclosures: Elliott S. Block, DO: No financial relationships or conflicts of interest

Case Description: The patient had recent onset of hypertension with renal compromise and was awaiting further renal workup when she presented to the emergency department with intractable headaches, left hemiparesis, and lethargy. Imaging revealed right basal ganglia intraventricular hemorrhage, and after acute stabilization, she was transferred to inpatient rehabilitation. Nephrology was consulted for elevated creatinine. Workup revealed P-ANCA positivity with 1:320 titers and renal biopsy revealed focal, segmental and global glomerulosclerosis (56% global sclerosis) with associated moderate interstitial fibrosis and tubular atrophy. She was started on high-dose prednisone and received rituximab. Her kidney function subsequently improved, and blood pressure controlled with metoprolol.

Setting: Acute inpatient rehabilitation hospital

Patient: A 19-year-old female with hemorrhagic stroke related to P-ANCA nephritis Assessment/

Results: Throughout the workup and management of her nephritis and blood pressure, she participated in a comprehensive rehabilitation program, and amantadine and methylphenidate were used to address alertness and attention deficits which were barriers to therapy participation. Her FIM measures improved from maximal/moderate assistance to minimal assistance/supervision for mobility and ADLs. The patient and family were educated on her condition and importance of medication compliance. After discharge the patient was compliant with medications, improved kidney function with continued rituximab, and regained independence with outpatient therapies. She was able to return to her studies at junior college.

Discussion: This is the first case reported, to our knowledge, of a young female with hemorrhagic stroke as a presenting sign of P-ANCA glomerulonephritis. Having the patient in acute inpatient rehabilitation allowed for concurrent workup while participating in therapies, and creating a discharge plan to prevent future strokes.

Conclusion: Rare underlying causes should be considered in otherwise unexplained cases of stroke. This case also emphasizes the importance of inpatient rehabilitation as a setting in which comprehensive evaluation and workup can be completed during acute recovery.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/rehabilitation-of-hemorrhagic-stroke-related-to-hypertensive-emergency-in-a-young-female-with-p-anca-nephritis-case-report/