Rehabilitation notes

This person had an unusually large CPA tumour that compressed the pons, medulla, cerebellum and the jugular foramen. The tumour was resected successfully and histopathology confirmed transitional meningioma (WHO grade 1).  Post operatively left cerebellar infarction was observed.

Clinically the client experienced dense left facial palsy, dysarthria, dysphonia (requiring left vocal augmentation), severe dysphagia (requiring PEG), immobility due to poor balance and vertigo. It is unusual to observe this extent of impairments after CPA tumour resections ^1-3, unless the tumours are large enough to compress the brain stem and cranial nerves ⁴. In this case, the likely reasons for the extensive impairments were the impact of the tumour of the medulla and pons (swallow) as well as CNs VII (dysarthria and drooling), VIII (balance and vertigo), IX and X in the jugular foramen (swallow). The cerebellar infarct may have also contributed to the swallowing difficulties⁵ and disturbances in balance and vertigo.

Despite the significant impairments and slow gains, the client was able to achieve meaningful functional recovery. After 8 months of intensive inpatient and outpatient rehabilitation, the PEG was removed and normal diet/fluids were re-established.  Dysarthria was mostly resolved, left facial palsy persisted and dysphonia was mild. The client was mobilising independently with a gait aid and with improved endurance.

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Co author: Ettie Ben-Shabat PhD MAPT (neurological physiotherapy), B.App.Sci (physiotherapy)