PARALEGIA FOLLOWING BILATERAL FRONTOPARIETAL HEMORRHAGE: A CASE REPORT

Paraplegia is rarely seen in cerebral injuries.Tumors, lesions, ischemia or hemorrhage of bilateral parasagittal frontoparietal zone –which is supplied by anterior cerebellar artery- may result in paraplegia. Here in, we describe the case of a man with paraplegia following bilateral frontoparietal hemorrahage. 65 year old male patient with paraplegia following bilateral frontoparietal hemorrhage was hospitalized in our clinic for rehabilitation and further investigation. He had no previous significant medical history.He presented with cognitive impairment, agitation and insomnia symptoms. On assessment he had hip and knee flexion contracture and spasticity. Muscle strength testing showed grade 3/5 proximally, and grade 2/5 distally. He wasn’t able to sit or walk indepently. He had urinary incontinence. Physical examination revealed no sensory or reflex impairment. His cerebellar findings were evaluated to be normal. On his follow up, plain radiographs of knee and pelvis revealed severe heterotopic ossification (HO). Due to partial response to full dose antispastic oral treatment, baclofen test dose was administered intrathecally. After the good response to screening test, baclofen pump insertion was planned. Before any orthopedic intervention for heteretopic ossification, scintigraphic evaluation was ordered. His sintigraphy showed ongoing HO activity. The patient is still under observation. Paraplegia secondary to bilateral frontoparietal hemorrhage and spasticity, contractures, incontinence, HO and cognivite impairment following it, reduces the quality of life and make the rehabilitation process harder