1145 - Beating the odds: functional recovery after spinal cord infarct following abdominal aortic aneurysm repair

64-year-old male with history of hypertension, cerebrovascular accident, and myocardial infarction who presented to acute care hospital (ACH) with abdominal pain and syncopal event, found to have a ruptured abdominal aortic aneurysm (AAA) leading to spinal infarct. 

CTA demonstrated large AAA with rupture and retroperitoneal hematoma. Vascular surgery completed endovascular repair. At ACH developed bilateral lower extremity weakness, right >left, due to associated hypoperfusion to the spine.

Discussions:

Prior to the injury, he was independent with ADLs/iADLs. On admission to acute inpatient rehabilitation (AIR), he demonstrated profound right lower extremity weakness (HF 1/5, KE 2/5, ADF 0/5, EHL 1/5, APF 1/5) secondary to spinal cord infarct following AAA repair. He required minimum-moderate assistance with bed mobility, total assistance for transfers, and Sara Stedy for standing tasks. He required total assistance for toileting, toilet transfers, and lower body dressing, and maximum assistance for showering/bathing. On day 12 of AIR, ISNCSCI resulted in T11 AIS D classification. Throughout his 23-day AIR stay, he showed remarkable recovery, improving to 5/5 strength in most right lower extremity muscle groups, except EHL (2/5) and APF (4/5). He achieved all short- and long-term goals with independence in bed mobility and all transfers with a rolling walker or wheelchair. He ambulated 180 feet with a rolling walker and performed all ADLs independently with adaptive equipment.

Conclusions: This case illustrates the potential for meaningful neurologic and functional recovery following spinal cord infarction secondary to AAA repair. Despite the typically poor prognosis, early and intensive inpatient rehabilitation facilitated near complete independence, underscoring the importance of comprehensive rehabilitation in optimizing outcomes for patients with vascular spinal cord injuries.