Elizabeth Chang, MD
Resident Physician
Schwab Rehabilitation Hospital and Care Network/University of Chicago
Naperville, Illinois, United States
Steven Le, MD
Resident Physician
Schwab Rehabilitation Hospital
Chicago, Illinois, United States
Raymond Lee, MD
Attending Physician
Schwab Rehabilitation Hospital
Chicago, Illinois, United States
T1 motor ASIA A complete paraplegia secondary to gunshot wound with concurrent left hemispheric ischemic stroke due to left common carotid artery injury Comprehensive spinal cord injury (SCI) rehabilitation is dependent upon successful patient acquisition of knowledge and functional capacity to maximally self direct care. The goal of rehabilitation should focus on preventing SCI-related morbidity and further loss of function. In cases of concurrent neurological diagnoses, such as stroke, cognitive sequelae may substantially impair or delay this process. In the acute rehabilitation setting, an early focus on optimizing cognitive functioning by targeting memory, aphasia, and problem solving has the potential to empower patients to have greater independence and minimizes future morbidity.
Case Description: A 25-year-old male with no significant medical history presents following multiple gunshot wounds resulting in fractures of the T1-T2 vertebrae and injury to the left common carotid artery requiring repair with interposition graft. He was subsequently found to have a left MCA infarct associated with significant cognitive and communicative impairments and agitation. Patient underwent comprehensive therapies during an extended inpatient rehabilitation stay, with an emphasis on memory, problem solving, and multimodal communication strategies including semantic feature analysis treatment and communication board use. At time of discharge, patient demonstrated near full resolution of his aphasia, cognitive deficits, and mental status changes, as well as independence in managing an intermittent catheterization program and transfers.
Discussions:
Conclusions: This case presents a unique occurrence of concomitant traumatic spinal cord injury and stroke diagnoses. As with the well-described dual diagnoses of traumatic spinal cord injury and traumatic brain injury, this case underscores challenges posed by neurocognitive impairments on SCI rehabilitation and delineates the importance of early multimodal cognitive interventions as a first step to effective SCI rehabilitation, so as to maximize the potential for achieving long-term independence and possibly reduce future clinical and economic burden.
