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1255 - Pregnancy and Neurological Uncertainty: Determining Autonomic Dysreflexia Risk in a Pregnant Patient with Chemo-Induced Neurological Complications

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

FM

Felix Mintah, MD

Resident Physician
H. Ben Taub Department of Physical Medicine and Rehabilitation Baylor College of Medicine
Houston, Texas, United States
JP

Jedidah Prum, MD

Resident Physician
H. Ben Taub Department of Physical Medicine and Rehabilitation Baylor College of Medicine
Pearland, Texas, United States

Corresponding Author(s)

LL

Loc Lam, DO

Resident Physician
H. Ben Taub Department of Physical Medicine and Rehabilitation Baylor College of Medicine
Houston, Texas, United States

Co-Author(s)

MA

Maaheen Ahmed, DO

Assistant Professor
H. Ben Taub Department of Physical Medicine and Rehabilitation Baylor College of Medicine
Houston, Texas, United States

Case Diagnosis: Chemo-induced Thoracic Level Spinal Cord Injury vs. Motor Polyneuropathy Secondary to Chemotherapy for Acute Lymphoblastic Leukemia

Case Description: A 30-year-old G1P0 woman, near-term with a 20-year history of presumed spinal cord injury (SCI) following chemotherapy, was referred to the PM&R clinic for autonomic dysreflexia prevention during labor. Diagnosed with Acute Lymphoblastic Leukemia (ALL) at age 7, she underwent chemotherapy with Daunorubicin, Cytarabine, Asparaginase, Methotrexate, and Vincristine. Seven months into treatment, she developed neurotoxicity leading to motor neuropathy, neurogenic bladder, and bowel dysfunction. Despite remission, she has persistent flaccid paralysis of the lower limbs, muscle atrophy, and hip/knee contractures. Her light touch sensory exam remains mostly intact, with pinprick deficits at T10 on the left and L2, S1 on the right, in locations where surgical scars are present, consistent with T9 ASIA B criteria. A recent spinal MRI was unremarkable, creating diagnostic uncertainty between SCI and motor polyradiculopathy. Early epidural anesthesia was recommended.

Discussions: This case highlights the complex diagnostic and management challenges in a patient with a presumed SCI secondary to chemotherapy who now faces pregnancy-related concerns. Despite her diagnosis of T9 ASIA B SCI, her intact sensory function and lack of AD episodes raise uncertainty about the true nature of her neurological injury. Chemotherapy-induced neurotoxicity complicates the picture, as motor neuropathy may mimic SCI. At this time, the patient desires a natural vaginal delivery. She agreed to further testing, including EMG, to clarify her diagnosis, hoping it would support her birth plan in the future. The patient’s preference for a natural vaginal delivery adds complexity, as we must balance her desires with the potential risk of AD during labor.

Conclusions: This case highlights the value of early physiatry involvement in complex neurological diagnoses, particularly in the pediatric cancer population, to optimize care and support patient-centered reproductive and neurological outcomes.