162 Views

533 - Navigating the Complexities of Olfactory Neuroblastoma: A Case Report on Diagnosis, Surgical Challenges, and Multidisciplinary Rehabilitation

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

VA

Vishal Anjutgi, MD

Resident Physician (PGY-2)
Montefiore Medical Center
New York, New York, United States

Co-Author(s)

AI

Anthony Iuso, DO

Resident Physician (PGY3)
Montefiore Medical Center
Bronx, New York, United States
Erika L. Trovato, DO, MS (she/her/hers)

Associate Chief Medical Officer, Program Director, Brain Injury Fellowship
Burke Rehabilitation Hospital
White Plains, New York, United States

Case Diagnosis: Olfactory neuroblastoma

Case Description: A 59-year-old patient presented to the ED with headaches and altered mental status; p</span>hysical exam was unremarkable. He received a brain MRI that revealed a diagnosis of olfactory neuroblastoma. He underwent tumor biopsy and resection via intranasal and intracranial approach. Post-operatively, the patient developed extensive intra-cranial edema requiring surgical site re-exploration, craniotomy infection, and right frontal posterior cerebral artery infarct. He then presented to acute inpatient rehabilitation with cognitive impairments, ataxia, and visual field changes, requiring a multidisciplinary care team. Rehabilitation focused on gait training and neuromuscular re-education to attain independence with ambulation. Cognitive and proprioceptive therapy was also vital to improve the speed of processing information and tracking visual stimuli, with the goal of achieving independence in ADLs. By discharge, the patient achieved independent ambulation with a rolling walker and made improvements in his cognitive deficits.

Discussions: Olfactory neuroblastoma is a rare (incidence 1 in 2.5 million) malignancy of the sinonasal tract with highly variable presentation. This malignancy poses unique rehabilitative challenges because of its location in the intranasal cavity and potential to expand into the intracranial space. Cranial nerve deficits, facial weakness, and vestibular abnormalities are possible complications that necessitate specific rehabilitative strategies. For example, vestibular therapy is essential for managing balance issues, and visual training is crucial to remedy visual field deficits that commonly affect these patients. Furthermore, patients are susceptible to post-operative infarcts due to reversible cerebral vasoconstrictive syndrome. This complication, which was present in this case, requires additional neuromuscular rehabilitative techniques such as proprioceptive neuromuscular facilitation.

Conclusions: This case demonstrates that olfactory neuroblastomas, although rare, should be included in the differential diagnosis of altered mental status and headache. It also highlights the importance of tailored, interdisciplinary care within the acute inpatient rehabilitation setting to optimize functional outcomes after intracranial tumor resection.