Multiple Sclerosis and other Neurological Conditions
Arpun Shah, DO, MPH
Resident Physician
Inspira Health Network
Mullica Hill, New Jersey, United States
Brandon J. Goodwin, DO
Resident Physician
John’s Hopkins Hospital
Toms River, New Jersey, United States
Morris Franco, DO
Dr. Morris Franco- Transitional year resident
Ocean University medical center
Long Branch, New Jersey, United States
Casey Schoenlank, MD
Director, Rehab Medicine Consult Services
Hackensack Meridian Johnson Rehabilitation Institute at Ocean University Medical Center
Brick, New Jersey, United States
Arpun Shah, DO
Ocean University Medical Center
Colonia, New Jersey, United States
Klippel-Trenaunay Syndrome and Glioblastoma Multiforme
Case Description:
Patient is a 69 year-old female with past medical history of Klippel-Trenaunay Syndrome, DVTs, and left foot equinovarus who presented to acute rehabilitation status post right parietal craniotomy for maximal resection of a glioblastoma.
Prior to admission, she presented with acute left hemiparesis with dysarthria, impaired proprioception, and dysmetria. MRI revealed a brain lesion. Biopsy revealed pathology consistent with glioblastoma multiforme IDH-wildtype Grade 4, which was later resected by neurosurgery. Klippel-Trenaunay Syndrome is a rare congenital disorder characterized by vascular, lymphatic, soft tissue, and bone abnormalities. This patient had several complications of this condition including port-wine stains, chronic left lower extremity weakness requiring a cane to ambulate, telangiectasia, and multiple DVTs. Her condition was later complicated by the presence of a brain tumor. Her situation involved several generalists and specialists to provide optimal care. Her case was unique as it required a custom brace to be created, while taking into account an acute DVT and telangiectasia present on her limb. In addition, she was not a candidate for therapeutic anticoagulation for about 7 days post-op. This required an IVC filter to be placed by vascular surgery. To our knowledge, this is only the second case reported regarding an association with Klippel-Trenaunay Syndrome and Glioblastoma Multiforme. This case highlights the importance of utilizing a multimodal approach to provide effective care, given the complexity of these medical conditions.
Post-op, she developed worsening foot drop and inability to compensate, as well as an acute DVT. Due to this patient struggled to initially partake in therapies at acute inpatient rehabilitation. Close collaboration between PT, OT, orthotists, physiatrist, and the neurosurgery teams allowed a multidisciplinary plan on addressing these deficits. She was fitted with a custom AFO, and strategies were developed and taught to the patient to meet rehabilitation goals.
Discussions:
Conclusions:
