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Rapid decline of a 52-year old female with brain injury during acute rehabilitation

Schroeder, Allison MD; Weppner, Justin DO; Galang, Gary MD

American Journal of Physical Medicine & Rehabilitation: June 17, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001246
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A 52-year-old African American female suffered a spontaneous right middle cerebral artery (MCA) aneurysm rupture treated with emergent right craniectomy and MCA artery clipping. She was admitted to inpatient rehabilitation (IPR) 6 weeks after her initial injury and was requiring maximum to total assistance for functional tasks. She made significant functional gains during the first 17 days of IPR admission, she developed headaches, new cognitive deficits, and increased difficulty with standing and eating. Her symptoms worsened at the end of the day. Physical examination demonstrated sunken craniectomy flap. Imaging revealed medialization of the craniectomy flap with local mass effect causing a 4 mm leftward shift with interval decrease in ventricular size consistent with syndrome of the trephined. While in IPR she was placed in the Trendelenburg position during rest breaks and overnight and was transferred to the neurosurgical service for definitive treatment with cranioplasty. After an additional IPR stay and subsequent outpatient therapy, she improved to a modified independent level of function.

University of Pittsburgh Medical Center

University of Pittsburgh Medical Center

University of Pittsburgh Medical Center

Corresponding Author: Allison Schroeder, 3471 Fifth Ave, Pittsburgh, PA 15213, Phone: (412) 692-4400,

The authors of this manuscript, Allison Schroeder, Justin Weppner, and Gary Galang, have nothing to disclose. No funding was received for this study.

Justin Weppner is in training.

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