Category: Spinal Cord Injury; Measurement
Objective : To investigate the treatment and rehabilitation needs in a patient with transverse myelitis.
Design: A case study with four week follow up after presentation.
Setting: Acute care hospital and acute inpatient rehabilitation (AIR)
Participants : A 20-year-old male with no past medical history was hospitalized after developing acute neck pain and rapidly progressive paresthesias and weakness in all limbs. Weeks prior to arrival, the patient experienced brief diarrhea associated with an upper respiratory infection while visiting the Middle East. MRI cervical spine demonstrated increased T2 FLAIR signal within the spinal cord from C3-C5 and was negative for disc herniation or spinal stenosis, and MRI brain demonstrated a right frontoparietal T2 focus within the deep white matter without enhancement. Cerebral angiogram and CT Angiography Head/Neck were negative for vascular abnormalities, cerebrospinal fluid analysis was normal, and infectious, autoimmune, and hypercoagulable workup was negative. On examination, the patient had proximal greater than distal weakness, worse in the upper extremity, 3+ bilateral patellar reflex, positive Babinski reflex, sensation impaired to light touch at the left L4/L5 dermatomes, and positive voluntary anal contraction and deep anal pressure. The patient was classified as C5 ASIA D. On the initial therapy evaluations: total-assist for supine to sit and lower body dressing, maximum-assist for grooming, stand by assist for static sitting balance, and moderate-assist for dynamic sitting balance.
David Jacobs– Resident Physician, Schwab Rehabilitation Hospital/University of Chicago, Chicago, Illinois
Khyrie Jones– Resident Physician, Schwab Rehabilitation Hospital, Chicago, Illinois
Lee Ray– Medical Director of Spinal Cord Injury Program, Schwab Rehabilitation Hospital and Care Network/University of Chicago, Chicago, Illinois
Ray Lee– Medical Director of Spinal Cord Injury Program, Schwab Rehabilitation Hospital and Care Network/University of Chicago, Chicago, Illinois