Disclosures: Matthew C. Severson, MD: No financial relationships or conflicts of interest

Case Description: While admitted to inpatient rehabilitation, the patient experienced the onset of progressive fatigue, decreased alertness, and headaches over the course of 2 to 3 days with associated functional declines in mobility and independence in activities of daily living. This change in clinical status occurred approximately 4 weeks after completion of craniospinal proton radiation therapy for treatment of a pineoblastoma following surgical resection. Laboratory workup for endocrine, metabolic, and infectious etiologies, including lumbar puncture, was negative. Magnetic Resonance Imaging of the brain was negative for acute changes. His medication regimen was scrutinized and simplified to eliminate medications that could contribute to lethargy. He continued participating in the required daily physical, occupational, and speech therapy during this time, but his ability to engage in these therapy sessions and demonstrate progress was severely affected.

Setting: Tertiary care adult and pediatric inpatient rehabilitation unit

Patient: An 18 year-old male status post pineoblastoma resection whose clinical course was complicated by left hemiparesis and hemineglect, central diabetes insipidus, hypothyroidism, obstructive hydrocephalus, and seizures Assessment/

Results: Given the negative workup and timing of his clinical decline in function, a diagnosis of subacute somnolence syndrome was suspected. In keeping with this diagnosis, he began to show improvements in alertness and physical function within 2 weeks after symptom onset.

Discussion: Fatigue and mental status changes are commonly encountered in patients with central nervous system (CNS) disease. Subacute somnolence syndrome has long been recognized but has not been well described in patients who have undergone proton radiation therapy for primary CNS malignancies. Its effects pose challenges unique to the patient undergoing intensive inpatient rehabilitation.

Conclusion: Subacute somnolence syndrome should be considered as a diagnosis of exclusion in patients who experience progressive fatigue and functional decline 4 to 6 weeks after completion of radiation therapy to the brain.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/somnolence-in-an-18-year-old-male-on-the-inpatient-rehabilitation-unit-a-case-report/