RESUMO
CASE DESCRIPTION: A five-year-old male with spastic quadriplegia cerebral palsy and an expressive communication disorder presented because the family desired liberalization of diet. The diet consisted of pureed solids and no liquids due to deficits identified on bedside swallow evaluation; further dysphagia assessment had not been obtained due to significant procedural anxiety. Comprehensive approaches were taken involving premedication with buspirone, desensitization, distraction, and positive reinforcement. The fluoroscopic swallow study was successfully completed, and the patient's diet was upgraded to include moderately thickened liquids. DISCUSSION: Procedural anxiety management in special populations is not well-researched. The lack of definitive recommendations regarding these issues increases the difficulty of managing these patients. This case highlights one successful approach to addressing individual needs using widely-available pharmacologic and environmental techniques. Additionally, this case reinforces the need to identify underlying causes for procedural anxiety and involve an interdisciplinary team. CONCLUSIONS: Attempts should be made to identify factors driving procedural anxiety. After discussing with the patient and family, relevant information should be relayed to staff with an open-ended invitation to propose ideas. While not all hospitals have equivalent resources, concerns related to unfamiliarity, underlying anxiety, and locus of control can be addressed with limited resource utilization, as demonstrated in this case.
RESUMO
INTRODUCTION: While the general principles of treatment of TM are agreed upon, the rarity of the disease has made determining its clinical course and etiology quite difficult. This report aims to inform these debates by demonstrating the susceptibility of at least one individual to transverse myelitis following an acute SCI. CASE PRESENTATION: This case report follows the clinical course of a 17 year old. Caucasian female that contracted transverse myelitis (TM) following an acute traumatic spinal cord injury. This patient originally presented as a T9 AIS A traumatic SCI, and was then re-graded as C6 AIS A SCI following diagnosis of TM. She was later seen in clinic for 6-month follow-up and displayed post-trauma baseline scores for both strength and sensation, indicating nearly complete recovery. DISCUSSION: In addition, this report demonstrates the importance of adequate clinical management of TM in practical terms of patient performance on clinical exams. This report also adds to the existing body of evidence suggesting early intervention is associated with better functional outcomes.
