The Vital Role of PM&R in the Neuro-Palliative Management of a Rare Pineal Parenchymal Tumor: A Case Report

Case Diagnosis: Pineal Parenchymal Tumor

Case Description or Program Description: A 38-year-old African American man with HIV, hepatitis C, and chronic back pain presented with headaches, ataxia, and cognitive decline. Workup revealed a pineal parenchymal tumor with hydrocephalus.

Setting: Neuro ICU

Assessment/Results: PM&R was consulted for spasticity management, neurogenic bowel and bladder, and positioning strategies, but had limited collaboration with palliative care for goals-of-care discussions. History of HIV and hepatitis C likely contributed to neuroinflammation, immunosuppression, and increased neurological vulnerability, while chronic pain and opioid use impacted rehabilitation engagement. Poor social support complicated discharge planning, access to post-acute rehabilitation, and adherence to care recommendations. Ultimately, the patient succumbed to tumor progression, highlighting the challenges of rehabilitation in complex neuro-oncologic cases.

Discussion (relevance): Pineal tumors comprise less than 1% of intracranial neoplasms, with limited literature on PM&R’s role in management. While neurosurgical and oncologic treatments are prioritized, early rehabilitation and palliative care integration can optimize function, manage symptoms, and guide goals-of-care.
This case underscores PM&R’s importance in neuro-oncology, even when full recovery is not possible. Spasticity control, dysphagia management, and caregiver training can enhance quality of life. However, poor social support significantly impacts outcomes for patients with complex conditions. Lack of a caregiver may limit access to inpatient rehabilitation, increase the risk of complications (pressure ulcers, malnutrition, infections), and contribute to healthcare disparities. In cases of limited financial resources, adherence to outpatient therapy and follow-up care may be poor. Early PM&R-palliative collaboration is essential to identify community resources, facilitate long-term care planning, and advocate for equitable access to rehabilitation services.

Conclusions: PM&R plays a crucial role in managing quality of life in patients with rare brain tumors. However, social determinants of health create significant barriers to recovery. Increased PM&R integration in neuro-palliative care, along with expanded access to rehabilitation services for socioeconomically vulnerable patients, is essential to improve outcomes in poor-prognosis neuro-oncologic conditions.