Multiple Sclerosis and other Neurological Conditions
Dan Yacubovich, BS
OMS-4
Rowan-Virtua
Somerdale, New Jersey, United States
Taraneh Alahdadi, BS,MS, MBA
Medical Student
St. George’s University
Citrus Heights, California, United States
Ankur Jain, DO
Doctor
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Daniel Khokhar, DO
Resident Physician
Johns Hopkins PM&R
Baltimore, Maryland, United States
Eliot Sadik, MD
Resident Physician
Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation
Baltimore, Maryland, United States
Brandon J. Goodwin, DO
Resident Physician
John’s Hopkins Hospital
Toms River, New Jersey, United States
Dan Yacubovich, BS
OMS-4
Rowan-Virtua
Somerdale, New Jersey, United States
Bing-Neel Syndrome (BNS), a rare central nervous system manifestation of Waldenström macroglobulinemia, with Monoclonal Gammopathy of Neurologic Significance. Therapy documentation demonstrated progressive gains in activity tolerance, core stability, and initiation of ambulation using body weight support and a pneumatic walker. These improvements highlight the role of rehabilitation in identifying and fostering functional progress in patients with rare neuro-oncologic disorders. Subtle advances in endurance, postural control, and safety may have a meaningful impact on quality of life, even when traditional outcome metrics are not emphasized. This case highlights the importance of physiatric involvement in recognizing and amplifying therapy-driven improvements in function, applying cancer rehabilitation principles such as activity modification, adaptive equipment, and complication prevention, and coordinating with oncology to align functional goals with systemic therapy. Cancer rehabilitation principles can be applied in rare neuro-oncologic conditions such as Bing-Neel Syndrome. Even without measurable gains on global scales, rehabilitation provides value through safety, functional monitoring, and interdisciplinary care.
Case Description: A 73-year-old right-handed man with Waldenström macroglobulinemia, L4–L5 spinal fusion, carpal tunnel and elbow release, and mononeuropathy multiplex presented with progressive neurologic decline. He initially developed intermittent numbness in his upper extremities in 2023, followed by numbness in his right lower extremity in 2024, which progressed to swelling, pain, and hip flexor weakness, eventually involving his left leg. A saphenous nerve and gastrocnemius biopsy showed no vasculitis. Lumbar puncture and CSF flow cytometry confirmed BNS and Monoclonal Gammopathy of Neurologic Significance. He had been treated with prednisone 60 mg daily, but discontinued due to side effects. One day prior to rehabilitation admission, Zanubrutinib was initiated. On evaluation, his AM-PAC score was 16, with subsequent assessments remaining stable. Rehabilitation interventions included mobility training, activity modification, adaptive equipment, fall prevention, and caregiver education.
Discussions:
Conclusions:
