Disclosures: Aaron Bolds, MD, MBA: No financial relationships or conflicts of interest
Case Description: 21-year-old basketball player without significant past medical history presented to ER with lower extremity weakness, more pronounced on left side. Patient reported having similar symptoms for past 2 years which were attributed to ankle sprains, with previous evaluations from podiatry, orthopedics and physical therapy. After no resolution of symptoms patient decided to go to ER and MRI spine revealed an intramedullary tumor at T9-T12 and syrinx at C2-T9.
Setting: Tertiary inpatient rehabilitation unit
Patient: 21-year-old male with a Spinal Pleomorphic Xanthoastrocytoma. Assessment/
Results: Patient subsequently underwent T9-T12 laminectomy and total resection of tumor. Patient was admitted to acute rehab 1-week post-op with exam of T10 AIS D. 1 week later patient required repeat operation for wound dehiscence and hematoma evacuation. 2 weeks later patient was re-admitted to acute rehab with lower extremity strength scoring equivalent to AIS C.
Discussion: Pleomorphic xanthoastrocytoma (PXA) is a WHO grade II tumor, representing less than 1% of CNS primary tumors. Literature review revealed only 6 cases of PXA in the spinal cord have been reported, 4 of which were managed with total resection without radiotherapy. To our knowledge we outline only the 7th case of this rare spinal cord neoplasm This case highlights the slow growing nature of this rare tumor, as patient was symptomatic for several months. It also highlights some of the complications of complete resection, the best known treatment at this time. Two of six previous cases were treated with adjunct radiotherapy, 1 of which died and the other had recurrence at 8 months.
Conclusion: The role of adjunct therapy and molecular studies is not well defined because of rarity of spinal cord pleomorphic xanthoastrocytoma, but should be considered. It is important that Physiatrists be aware of different types of spinal neoplasms, their presentations and treatment modalities.
Level of Evidence: Level V
To cite this abstract in AMA style:
Bolds A. The Ankle Sprain That Led to Paraplegia: A Rare Case Report of a Spinal Pleomorphic Xanthoastrocytoma [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/the-ankle-sprain-that-led-to-paraplegia-a-rare-case-report-of-a-spinal-pleomorphic-xanthoastrocytoma/. Accessed May 9, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-ankle-sprain-that-led-to-paraplegia-a-rare-case-report-of-a-spinal-pleomorphic-xanthoastrocytoma/