Poster 27 Analyzing the Patient Journey for Patients Living with Spastic Paresis

Abstract

encephalopathy; typically, cefepime-induced neurotoxicity occurs within a week after initiation of the agent. Conclusion: As increasingly medically complex patients on multiple antibiotic regimens are cared for in the acute inpatient rehabilitation setting, physiatrists require a heightened awareness for potential adverse effects from medications. Cefepime-induced encephalopathy should be suspected in the presence of acute mental status changes, even if the treatment duration exceeds a week. A 54-year-old male patient with history of resected glioma brain tumors recently hospitalized due to increased falls, decline in cognition, and transient bladder incontinence. Workup revealed glioma recurrence with ventriculomegaly from obstruction of the posterior right choroidal fissure. A ventriculoperitoneal (VP) shunt was placed to treat hydrocephalus yielding improvement in symptoms. On day three of rehabilitation admission, the patient experienced worsening sitting balance with waxing and waning ataxia, bladder incontinence, and confusion. Workup was unremarkable for infection, electrolyte imbalance, or medication toxicity. Repeat head CT demonstrated stable ventricle size. The patient's neurosurgery team made adjustments to the patient's VP shunt settings for known hydrocephalus which resulted in improvement of symptoms. Shunt adjustment was made two additional times due to return and worsening of hydrocephalus symptoms, now including bowel incontinence. MRI of the spine was requested in addition to the intracranial evaluation. MRI of the lumbar spine revealed leptomeningeal spread of glioma involving the entire spinal cord. Program Description: Academic university hospital and Private Inpatient rehabilitation hospital. Setting: Acute inpatient rehabilitation hospital. Results or Clinical Course: The patient's functional goals were adjusted to include spinal cord injury rehabilitation. The patient did well within this new rehabilitation framework. Discussion: This is the first reported case, to our knowledge, of leptomeningeal carcinomatosis presenting with symptoms nearly indistinguishable from peri-operative VP shunt malfunction, leading to high potential for misdiagnosis. Conclusion: We present a case of a patient with a primary brain tumor that caused obstructive hydrocephalus and was treated with a VP shunt. It is important to maintain a high index of suspicion that includes the entirety of the CNS in this patient population, despite symptoms that seem to localize to intracranial lesions and devices.