1104 - Acute Inpatient Rehabilitation Status One Year After Onset of a Rare Case of Acute Sensory and Autonomic Neuronopathy (ASANN)

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Co-Author(s)

NB

Nico Bulatao, n/a

Medical Student
Mercer University School of Medicine
Georgia, Georgia, United States

Presenting Author(s)

DP

Davong D. Phrathep, DO

Resident
Mayo Clinic Florida
Jacksonville, Florida, United States
JL

Justine Levesque, MD

Resident
Mayo Clinic Florida
Jacksonville, Florida, United States
SW

Sydney Woods, MD

Resident
Mayo Clinic Florida
Jacksonville, Florida, United States

Co-Author(s)

BH

Brian Higdon, MD

Physician
Brooks Rehabilitation Hospital
Jacksonville, Florida, United States

Submitter(s)

DP

Davong D. Phrathep, MS

Lake Erie College of Osteopathic Medicine
SAINT PETERSBURG, Florida, United States

Case Diagnosis: Acute Sensory and Autonomic Neuronopathy

Case Description: A previously healthy 22-year-old male developed acute back pain, limb weakness, and dysautonomia following a marathon in May 2024. Initially given a working diagnosis of Guillain-Barré Syndrome (GBS), this was later altered to acute sensory and autonomic neuronopathy (ASANN) based on EMG and MRI findings. Despite preserved motor strength, he developed tetraplegia, respiratory failure requiring tracheostomy, neurogenic bladder, gastroparesis, bilateral corneal ulcerations, and severe autonomic instability. His course was further complicated by neuropathic pain, severe anxiety, and polypharmacy sensitivity. He required prolonged TPN, enteric feeding, and extensive inpatient rehabilitation. By discharge, he was wheelchair-dependent, with improved strength (4–5/5), but persistent sensory ataxia limiting function. In Dec 2024, he was admitted to local community hospital for hypotension, aspiration, and bacteremia, and was subsequently transferred back to inpatient rehabilitation in March 2025.

Discussions: Upon return to rehabilitation, the patient required maximal assistance for mobility and self-care due to profound proprioceptive loss, evidenced by functional dependence despite full weight-bearing, poor coordination, and use of ataxia-targeting medications. Despite complex medical needs — pain control, autonomic instability, enteral feeds, respiratory support, and intravenous antibiotics — he remained cognitively intact and grossly engaged in therapy. Over 10 weeks, he regained strength, reduced respiratory support, and achieved greater independence, including 300-foot electric wheelchair propulsion and minimal assist for sit-to-stand. Sensory function remained markedly impaired. Autonomic function improved with blood pressure stability, although neurogenic bowel and bladder persisted. Concurrent management of psychiatric and sleep symptoms were also prioritized to improve mental well-being.

Conclusions: This case highlights the severe, multisystem disability of ASANN, mimicking GBS but involving both spinal cord and peripheral nerves, including GI autonomic function. Interdisciplinary rehabilitation enabled functional gains and cognitive preservation despite medical complexity. The patient was discharged to structured living with plans for SCI day treatment, limited by persistent proprioceptive deficits.