(Kiosk 1) Rapid Improvement in Proprioception and Balance in a Ballerina with Hemangioblastoma Resection in the Thalamic Region: A Case Report

Case Diagnosis: A 28 year old female with rapid improvement in proprioception and balance after resection of a hemangioblastoma of the left thalamus.

Case Description or Program Description: The patient presented with 1 month of gait instability and diplopia. MRI brain revealed a cystic mass in the left thalamus. The patient underwent a left temporal craniotomy for tumor resection. Post operation, she developed right homonymous hemianopsia, right sided weakness, right sided neglect, and global aphasia. She had absent proprioception of the first metatarsophalangeal joint and ankle of the right foot and absent light touch sensation of her right upper and lower extremities. On admission to acute rehab, the patient was correct 0/5 times when testing proprioception of her right first toe and ankle. On day 4, the patient began to regain light touch sensation to her right shoulder and right hip extending to her right knee. On day 5, the patient began to have improvement in proprioception of her right ankle and was correct 2/5 times.

Setting: Tertiary care teaching hospital

Assessment/Results: After two weeks of working with physical and occupational therapy, the patient regained proprioception of the first metatarsophalangeal joint of the right foot (correct 4/5 times). Her therapists noted rapid improvement in both balance and walking, despite continued absent sensation of the right lower extremity below her knee. She also showed improvement in exercises with mirroring, coordination on heel to shin, and anticipatory/ reaction balance. At the time of discharge, she scored a 52/56 on the Berg balance scale and was able to walk outside.

Discussion (relevance): This is the first reported case, to my knowledge, of rapid improvement in proprioception and balance in a ballerina after resection of a hemangioblastoma in the thalamic region.

Conclusions: A patient’s background as a ballerina can lead to rapid improvement in proprioception and balance despite thalamic resection.