CHSU Discovery

Abstract

Case Diagnosis: A 51-year-old woman with a past medical history significant only for BPPV presents with an unusual presentation of acute transverse myelitis that is subsequently treated with medical management and four weeks of intensive inpatient PT/OT rehabilitation.

Case Description: The patient initially visited the emergency department with bilateral upper and lower extremity weakness symptoms. She was discharged with a lidocaine patch after CT showed prominent posterior osteophytes at C6-C7 with mild left-sided foraminal narrowing. She returned the same day with complete loss of sensation on the left side, numbness, tingling, BPPV-related symptoms, and loss of feeling of bladder fullness. MRI without contrast revealed a T2-hyperintense signal over the cervical spine consistent with edema of C5-C6. The patient was diagnosed with transverse myelitis and was given IV pulse therapy with high-dosemethylprednisolone 1g daily for the first five days, followed by plasma exchange therapy for the subsequent five days. The patient was then admitted for inpatient rehabilitation, consisting of at least 3 hours daily of combined PT/OT for the next four weeks.

Discussion: The exact mechanisms underlying the initiation and progression of transverse myelitis have yet to be fully understood and may vary among individuals. Additionally, the specific triggers and immune responses involved in transverse myelitis can differ, leading to heterogeneous clinical presentation and outcomes. Typically, these triggers are associated with specific autoimmune and viral sources. We present a unique case of a patient who only has a background of recurrent tension headaches and Benign paroxysmal positional vertigo.

Setting: This case occurs in a community hospital system, followed by admission to an inpatient rehabilitation hospital.

Assessment/Results: Before admission, the patient was completely independent. Comparisons of initial and final occupational and physical therapy evaluations of functional ability showed noteworthy improvements, with tasks like toilet hygiene increasing from 01 to 03, rolling left and right from 01 to 06, sitting to lying down from 01 to 04, and chair/bed to chair transfer from 01 to 05. However, activities like walking 10ft on an uneven surface, 50ft with two turns, and 150 ft remained unchanged at 01.

Conclusions: The patient was discharged with significant improvements in self-care parameters thereby reducing care-giver burden. However, the longevity of these self-care improvements is unclear and will require further exploration.