Disclosures: Breanna Benjamin, DO: No financial relationships or conflicts of interest

Case Diagnosis: Spastic Quadriparesis secondary to Powassan encephalitis

Case Description: Powassan encephalitis results from a rare tick-borne flavivirus that can have neuro-invasive effects. The patient is a 63-year-old male with history of Chronic Lymphocytic Leukemia (in remission), intracardiac shunt due to PFO/ASD, and spastic quadriparesis secondary to Powassan encephalitis. After two rounds of botulinum toxin injections proved successful in improving his spasticity, the patient was referred for elective intrathecal baclofen pump (ITB) placement to treat his spastic quadriparesis. At baseline, he had expressive aphasia and severe dysphagia for which he was recommended soft solid and thickened liquids diet. On physical exam, he was generally deconditioned, extensor spasticity 3 on the Modified Ashworth Scale (MAS) and flexor spasticity MAS 2 in all extremities. Sensation was intact and reflexes were 2+ . MRI brain showed cerebellar atrophy. Initially, he ambulated 10 ft and transferred with maximal assist.

Setting: Acute Inpatient RehabilitationAssessment/

Results: This led us to hypothesize that bulbar muscle spasticity resulting from Powassan encephalitis may be improved by ITB administration. This is significant as there are currently no known disease-modifying treatments for Powassan Encephalitis and there is limited research on specific treatments beyond personal protective measures against tick exposure.

Discussion: Daily ITB pump dosage was slowly titrated by 10% increments every 3-4 days (initial dose 25.5 mcg/day and final dose 38.35 mcg/day). Improvement in spasticity was noted in all extremities (extensors improved from MAS 3 to 1+; flexors improved from MAS 2 to 1). Functionally, he ambulated 50 ft with RW and performed turns with minimal assistance. Interestingly, improvements were also seen in his dysphagia and phonation, which is an unusual effect of administering baclofen via an ITB pump.

Conclusion: This case presentation demonstrates that ITB pump placement and titration to appropriate daily dosage is a possible treatment recommendation for those with spastic tone, dysphagia and speech/phonation sequelae from Powassan encephalitis.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spastic-quadriparesis-secondary-to-powassan-encephalitis-and-the-unexpected-effects-of-an-intrathecal-baclofen-pump-a-case-report/