Referral bias may explain the higher (40%) incidence of lymphoma in this population of LyP patients, compared with the 10-20% incidence commonly cited in the literature. In the subset of patients presenting with LyP alone, only 18% later developed lymphoma. Male patients or patients with prior EBV infection may have a higher risk for developing lymphoma, and some patients improved with treatment of putative infectious triggers.

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Spinal cord injury (SCI) is a catastrophic event with multiple comorbidities including spastic paralysis, sensory loss, autonomic dysfunction with sympathetic blunting, neurogenic orthostatic hypotension, neurogenic restrictive and obstructive lung disease, neuropathic pain, spasticity, neurogenic bladder, neurogenic bowel, immobilization hypercalcemia, osteopenia/osteoporosis, neurogenic obesity, and metabolic dysfunction. Cervical and thoracic SCI is all too often accompanied by traumatic brain injury (TBI), which carries its own set of comorbidities including headaches, seizures, paroxysmal sympathetic hyperactivity, aphasia, dysphagia, cognitive dysfunction, memory loss, agitation/anxiety, spasticity, bladder and bowel incontinence, and heterotopic ossification. This manuscript will review the etiology and epidemiology of dual diagnoses, assessment of both entities, and discuss some of the most common comorbidities and management strategies to optimize functional recovery.

A previously independent 66-yr-old right-handed man presented with right-sided weakness, preferring the lower limbs with additional impaired gait and dysarthria for 1-day duration. Imaging found a large left hemispheric anterior cerebral artery ischemic infarction with multiple lacunar infarcts. He exhibited frontal, callosal, and posterior variants of alien hand syndrome, which impeded activities of daily living. Though limited in evidence, a trial of clonazepam was initiated based on previous case reports describing suspected efficacy. Botulinum toxin A was not used given the patient’s immediate need and limited hospital length of stay. Right upper limb constricting therapies improved intermanual conflict and spontaneous grasping and levitation (arm elevation in retroflexion) activity; however, concomitant left upper limb motor apraxia complicated task-oriented activities. The combination of pharmaceutical and therapeutic interventions improved the patient’s quality of life as assessed by clinical observation, functional independence measures from 41 to 57, and patient reporting. This case report aims to increase awareness of a potential barrier to rehabilitation of a debilitating and rare condition and to discuss current assessment tools and treatment options supported by available evidence.