Disclosures: Hyunwoo J. Choo, MD: No financial relationships or conflicts of interest

Case Diagnosis: Successful vent liberation and gait training in a teenager presenting with atypical, asymmetric quadriplegia following anterior spinal artery stroke.

Case Description: A 16 year old female with no prior medical history presented for acute pediatric rehabilitation with quadriplegia following anterior spinal artery stroke, affecting the cervical medullary junction and lower medulla. Presenting symptoms included severe back pain, and ascending paresthesia in both hands, with progressive quadriparesis. Tracheostomy and gastrostomy tube were placed in acute care for ventilatory and nutritional support. Her acute inpatient rehabilitation course was notable for motor recovery of her right side, with marked spasticity impacting her right upper extremity. Her left side remained flaccid without motor return. Neuromuscular ultrasound of her diaphragm demonstrated normal function on the right, and absent activity on the left. Given evidence of hemidiaphragm activity, the patient underwent successful wean from the ventilator over the course of six weeks. She also tolerated intense gait training, progressively requiring less assistance.

Setting: Acute Inpatient Rehabilitation Hospital, PediatricsAssessment/

Results: By approximately three months of inpatient rehabilitation, this patient was able to wean safely from the ventilator and is being considered for future decannulation. She also demonstrated significant progress with assisted gait.

Discussion: This case demonstrates two interesting findings including the rare presentation of asymmetric quadriplegia with spastic functional recovery on one side, and persistent flaccid paralysis on the other. Second, this asymmetry allowed for unanticipated functional progress than is expected in a patient with quadriplegia, such as gait training and ventilator liberation.

Conclusion: This case describes a teenager with atypically asymmetric quadriplegia: spastic hemiparesis with motor recovery on one side, and persistent flaccid hemiparesis on the other. Her ability to wean from the ventilator and undergo gait training demonstrates promising implications for patients with asymmetric quadriparesis, and expands the possibility of functional goals that can be achieved in the acute inpatient rehabilitation setting.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ventilator-liberation-and-recovery-of-gait-function-in-a-pediatric-patient-with-atypical-asymmetric-pattern-of-quadriplegia-from-an-anterior-spinal-artery-stroke-a-case-report/