Chief of PM&R Sunnyview Rehabilitation Hospital Schenectady, New York
Case Diagnosis: CNS Vasculitis
Case Description or Program Description: A 70-year-old female with history of 30 years of chronic vertigo presented with worsening vertigo, gait instability, staring episodes, seizures and expressive aphasia. Symptom onset was insidious and imaging showed multiple areas of increased T2 hyperintensity, most prominent in the right frontal lobe. She underwent right frontal craniotomy with resection. Post-operative pathology was significant for findings consistent with CNS vasculitis. She was treated with steroids and admitted to inpatient rehabilitation.
Setting: Inpatient Rehabilitation Hospital
Assessment/Results: This patient was admitted to the Brain Injury inpatient rehabilitation service and progressed well with intensive therapy including PT, OT and SLP. Her most significant impairments were expressive aphasia and generalized fatigue and weakness, all of which saw significant improvements during her stay. She was also noted to have significant mood lability, anxiety, and perseverative thinking. She was started on sertraline for these complaints with significant improvements noted. She was discharged to home following acute inpatient rehabilitation. She continued to make substantial functional gains as an outpatient with both medical and therapeutic interventions.
Discussion (relevance): CNS vasculitis is an exceedingly rare disease with a small number of documented cases in the medical literature. There is no significant medical literature on the acute rehabilitation of this patient population. The pathophysiology of this disease features acute inflammation of the vessels that feed the brain and presentation can be variable with headache being the most common symptom, but significant focal neurological deficits are often seen that will often correspond to vascular territories signifying a significant injury to the CNS. The prognosis with CNS vasculitis is based on time to diagnosis and treatment, however, this population can benefit from intensive therapeutic and medical interventions that are used in stroke and TBI.
Conclusions: CNS vasculitis can present with symptoms, focal neurological findings, and functional impairments that are very similar to stroke or TBI. Although more research is needed, we suggest that this patient population would similarly benefit from acute inpatient rehabilitation to achieve functional gains similar to the benefits seen in stroke and TBI populations. We recommend acute inpatient rehabilitation for CNS vasculitis patients with significant neurological deficits.