Attending Physician MossRehab Elkins Park, Pennsylvania, United States
Case Diagnosis: Intramedullary spinal cord ependymoma
Case Description: A 24-year-old independent woman G1P1 through Caesarian-section three days prior presented to acute care with new onset urinary incontinence and lower extremity weakness. Magnetic resonance imaging revealed an intramedullary spinal cord mass extending from the C7 to T1 and T3 to T4 regions with cord edema. She underwent a T1 to T4 posterior laminectomy with tumor debulking. Pathology revealed a grade II ependymoma. The patient was admitted to acute inpatient rehabilitation. On admission, she was a C8 AIS A. She was unable to ambulate and required maximum to total assistance with functional activities. Additionally, she felt hopeless because was unable to care for her newborn. After 50 days of intensive rehabilitation, she had progressed to a C8 AIS C. She was independent with mobility at wheelchair level. Transfers and most ADLs were performed with independence to minimal assistance. Parenting tasks were performed at a modified independent to supervision level.
Discussions: Primary spinal cord tumors are rare. The frequency of intramedullary tumors is 5% with ependymomas making up 60% of this diagnosis. The data regarding the recovery from disability is limited due to the rarity of these tumors. In this case, an intensive inpatient rehabilitation resulted in significant functional improvement with eventual discharge to home and decreased caregiver burden. The patient’s mood had also significantly improved by the time of discharge as she felt confident in her abilities to care for her child.
Conclusions: Acute inpatient neurorehabilitation for patients with an intramedullary spinal cord ependymoma can yield substantial functional and psychological benefits to allow a safe discharge home with optimized level of independence.