851 - Never Too Rare to Rehab: CNS Hemangiopericytoma

Case Diagnosis: Intracranial hemangiopericytoma with spinal metastases

Case Description: A 47-year-old male presenting with headache and confusion was found to have a large posterior fossa intracranial hemorrhage secondary to recurrent CNS hemangiopericytoma (HPC) with new spinal metastases. He underwent emergent craniotomy for hemorrhage evacuation and tumor resection, followed by spinal tumor resection with thoracic fusion. Post-operatively, he had dysphagia, dysarthria, and severe mobility deficits secondary to ataxia and central vertigo. Despite his prognosis, he chose to pursue aggressive cancer treatment and inpatient rehabilitation. Due to his debilitating headache, vertigo, nausea, and fatigue, he initially required maximal assistance with mobility and ADLs. He had limited baseline tolerance for rehabilitation; through intensive medical management, his tolerance significantly improved. His mobility deficits were addressed with both traditional and innovative rehabilitation techniques, including virtual reality platforms. At discharge, he progressed to independent for ADLs and supervision for mobility, allowing candidacy for ongoing oncologic treatment. Today, he maintains independence and tolerates ongoing radiation treatment.

Discussions: HPCs are exceedingly rare CNS tumors with a high propensity for local recurrence and metastasis. Oncologic treatments are often based on limited case series. This patient presented with recurrent and metastatic intracranial HPC that was further complicated by a large posterior fossa hemorrhage. Rehabilitation is often overlooked in complex oncologic cases such as the one presented here given their poor prognostic outcomes. However, with aggressive symptom management and intensive rehabilitation from a specialized cancer rehabilitation team, this patient made remarkable improvements and was nearly independent at discharge. His functional gains also enhanced his candidacy for and increased tolerability of his subsequent cancer treatment.

Conclusions: Intracranial HPC is rare in oncology and rarer in the rehabilitation space. This case highlights the importance of cancer rehabilitation in optimizing a patient’s physical recovery, enhancing their ability to tolerate treatment and improving quality of life during and after cancer care.