(Kiosk 4) Diagnosis of Progressive Supranuclear Palsy Following Traumatic Spinal Cord Injury: A Case Report

Case Diagnosis: Progressive Supranuclear Palsy

Case Description or Program Description: A 64 year old female with a history of falls and diagnosis of Functional Neurologic Disorder (FND) presented to acute care after falling backwards down stairs. She sustained a cervical spinal cord contusion with fractures and underwent a C5-C6 Anterior Cervical Discectomy and Fusion. She was transferred to acute inpatient rehabilitation and was found to have a C3 American Spinal Injury Association (ASIA) Impairment Scale D injury. During admission she was noted to have hypophonia, bradykinesia, difficulty with eye movements, and insomnia. She participated in rehabilitation, progressed to contact guard - minimal assistance for transfers and ambulation with a rolling walker, and was discharged home.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: After discharge her neurological status declined including worsening rigidity and bradykinesia not responsive to levodopa. 10 months later, she was diagnosed with Progressive Supranuclear Palsy (PSP) in the severe stages and hospice care was recommended.

Discussion (relevance): During rehabilitation the patient was thought to have a spinal cord injury (SCI) with FND explaining symptoms that did not fit her SCI. However, the patient had undiagnosed PSP, a disease with no cure that typically progresses rapidly and requires a different approach than FND or SCI. An earlier diagnosis may help patients make important decisions and access resources such as home or hospice care.

Conclusions: Physiatrists should consider a thorough differential when treating patients with unusual symptoms and be attentive to potential patterns. A presentation of unexplained postural instability and especially backwards falls, ocular motor dysfunction, akinesia, and cognitive dysfunction should spark the physiatrist to consider the possibility of PSP alongside other neurodegenerative parkinsonian disorders. The physiatrist can play a critical role in identifying less common diseases after presentations such as falls, and can facilitate appropriate workup and treatment.