1137 - Case Report: A 20yo female with Glioblastoma Multiforme (GBM) of the spine in inpatient rehab.

A 20-year-old female was admitted to inpatient rehabilitation (IPR) for worsening bilateral lower extremity weakness and paresthesia. Two months after symptom onset, she underwent a T11–12 laminectomy with biopsy and was diagnosed with primary spinal glioblastoma (IDH-wildtype, WHO grade 4). She began radiation and temozolomide therapy. 

On IPR admission, she was a T9 ASIA A with 0/5 lower extremity strength, absent light touch below the umbilicus, and required MaxA for bed mobility, Mod-MaxA for transfers, and was non-ambulatory. Despite no neurological improvement, she progressed to ModI with wheelchair and transfer board and SetupA for most ADLs with exception of ModA for toileting and lower body dressing. 

Her stay was complicated by headaches, urinary retention, and an unsafe discharge plan due to living on the second floor. Her 84-day stay necessitated continuing chemotherapy during IPR but developed suspected idiopathic intracranial hypertension, prompting a transfer back to acute. 


Discussions:

GBM is the most aggressive primary brain tumor, accounting for 45% of cases and affecting ~14,000 individuals annually in the US, with median survival of 12-15 months despite maximal treatment. Primary spinal GBM is rare (< 1.5% of GBMs) and carries a poor prognosis, with survival averaging 10-14 months. Patients typically present with pain, weakness, and autonomic dysfunction. 

Although life expectancy is limited, spinal tumor–related SCI accounts for 10–26% of admissions to specialized units. Inpatient rehabilitation can yield meaningful functional gains, comparable to stroke or TBI, particularly when goals emphasize quality of life and align with functional potential. 


Conclusions: This case underscores the value of inpatient rehabilitation in spinal GBM, a rare and highly morbid condition. Despite its poor prognosis, early function-focused rehab can improve independence, support discharge planning, and align goals with prognosis and patient values.