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General Rehabilitation

Unexpected Allies: A Case Report of Spontaneous Neurological Recovery of Chronic Stroke Deficits Following Pubic Ramus and Acetabular Fractures

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 1

    Poster Presenter(s)

  • Brandon Amirian, MD

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

    • Co-Author(s)

  • KS

    Kody K. Sumida, DO

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Brooklyn, New York

  • Stefan Hamaway, MD

    Resident Physician
    State University of New York (SUNY) Downstate Health Sciences Univ PM&R Program
    Old Westbury, New York

  • SA

    Sanjeev Agarwal, MD

    Program Director
    SUNY Downstate Health Sciences University
    Brooklyn, New York

Disclosure(s):
Brandon Amirian, MD: No financial relationships to disclose
Stefan Hamaway, MD: No financial relationships to disclose
Sanjeev Agarwal, MD: No financial relationships to disclose
Case Diagnosis: Neurological recovery of stroke deficit following pelvic fractures

Case Description or Program Description: A 78-year-old male, with history of a hemorrhagic stroke 10 years prior, affecting the right temporal lobe, basal ganglia and thalamus resulting in left hemiparesis, presented after falling on his left hip. Prior to the fall, the patient lacked sensation to light touch and pinprick in his left leg and had decreased left leg strength and foot drop, as reported by the patient and his family. Documentation of prior sensory and motor function could not be obtained. Remarkably, following his fall, exam showed improvement of at least one grade of strength in left knee flexion, plantarflexion, dorsiflexion and extensor hallucis longus along with improved light touch and pinprick sensation in the L4-S1 dermatomes.

Setting: Acute inpatient rehabilitation

Assessment/Results: CT pelvis: acute comminuted left inferior pubic ramus and inferomedial acetabular wall

Discussion (relevance): Given local improvement only seen in the lower extremity after the fracture, we hypothesize that local factors contributed to this recovery. It is documented that peripheral nerves of hemiparetic limbs are affected following stroke. Bone fractures are associated with increased activity of neuropeptides such as nerve growth factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF), which have been shown to induce nerve healing. We hypothesize that this patient’s fracture and the subsequent release of NGF and BDNF may be implicated in the improvement of sensory and motor nerves in his previously affected limb.

Conclusions: We document a unique case where trauma in a stroke patient resulted in improvement of a chronic stroke deficit. This report is limited by the lack of medical documentation of the patient’s exam prior to the fracture. This case sheds light on less-understood aspects of neuro-recovery and may help develop therapeutic approaches in stroke rehabilitation. Further research should be conducted on the role fractures play in affecting stroke deficits.