Aishah Ahmad Fauzi

Parent‐reported pain in non‐verbal children and adolescents with cerebral palsy

This cross‐sectional study aimed to determine the prevalence, frequency, and intensity of parent‐reported pain among non‐verbal children with cerebral palsy (CP) and explore associations with medical, demographic, and parental psychosocial factors.

Incomplete paraplegia caused by extramedullary hematopoiesis in a patient with thalassemia intermedia

Introduction:Extramedullary hematopoiesis (EMH) is the production of blood cell precursors outside the bone marrow that occur in various hematological diseases. In patients with thalassemia intermedia, ineffective erythropoiesis drives compensatory EMH in the liver, pancreas, pleura, spleen, ribs and spine.Case Presentation:We describe a patient with thalassemia intermedia who presented with acute neurological symptoms caused by paraspinal EMH, which responded well to combination therapy of steroid, hypertransfusion, laminectomy and excision of pseudotumor and hydroxyurea therapy to boost the formation of fetal haemoglobin.Discussion:Prompt recognition of EMH based on clinical presentation and typical radiological findings should be made. Early treatment is recommended to prevent irreversible damage to the spinal cord.

Diagnostic dilemma of sacral abscess presented with seizure and altered conscious level in a patient with spinal cord injury

Context: Infection and septicaemia may clinically presented with seizure and altered conscious level. In spinal cord injury (SCI) population, they are at risk of having pressure ulcer which can be complicated further with infection and septicaemia. Findings: A 40-year-old man with complete T4 SCI and multiple clean and non-healing pressure ulcers at sacral and bilateral ischial tuberosity regions was initially admitted for negative pressure wound therapy (NPWT) dressing. He had an episode of seizure and subsequently had fluctuating altered conscious level before the diagnosis of deep-seated sacral abscess was made and managed. Prior investigations to rule out common possible sources of infections and management did not resolve the fluctuating event of altered consciousness. Clinical relevance: We presented an unusual case presentation of septicemia in a patient with SCI with underlying chronic non-healing pressure ulcer. He presented with seizure and fluctuating altered conscious level. Even though a chronic non-healing ulcer appeared clinically clean, a high index of suspicion for deep seated abscess is warranted as one of the possible sources of infection, especially when treatment for other common sources of infections fails to result in clinical improvement.

International Spinal Cord Society (ISCoS) database: Asian Spinal Cord Network (ASCoN) Pilot Project [IDAPP]

Study designGlobal mapping project of ISCoS for traumatic spinal cord injury (T-SCI) highlighted paucity of data from low and middle income countries (LMICs). Recognizing this gap, IDAPP study of one year duration was proposed as the first step to develop an International SCI database.ObjectivesPrimary objective was to assess database variables, processes involved and web platform for their suitability with a view to provide guidance for a large scale global project. Secondary objective was to capture demographic and selected injury/safety data on patients with T-SCI with a view to formulate prevention strategies.SettingNine centers from Asia.MethodsAll patients with T-SCI admitted for first time were included. International SCI Core Data Set and especially compiled Minimal Safety Data Set were used as data elements. Questionnaire was used for feedback from centers.ResultsResults showed relevance and appropriateness of processes, data variables and web platform of the study. Ease of entering and retrieval of data from web platform was confirmed. Cost of one year IDAPP study was USD 7780. 975 patients were enrolled. 790 (81%) were males. High falls (n = 513, 52%) as a cause and complete injuries (n = 547, 56%) were more common. There was a higher percentage of thoracic and lumbar injuries (n = 516, 53%).ConclusionsThe study confirms that establishing the SCI database is possible using the variables, processes and web platform of the pilot study. It also provides a low cost solution. Expansion to other centers/regions and including non-traumatic SCI would be the next step forward.

Asymptomatic tachycardia and acute pulmonary embolism in a case of tuberculosis spondylodiscitis

IntroductionTachycardia, or elevated heart rate is one of the important clinical parameters considered when diagnosing pulmonary embolism (PE) based on Wells’ criteria. However, tachycardia is not highly specific and commonly presents in many other conditions.Case presentationA 29-year-old female with incomplete paraplegia secondary to tuberculosis (TB) spondylodiscitis presented with asymptomatic sinus tachycardia. The related medical conditions, including anaemia, acute coronary syndrome, hyperthyroidism and other infective causes had been ruled out. Deep venous thrombosis was not on the list of differentials as she showed improvements in neurological and mobility functions with no clinical signs of calf pain or swelling. She had moderate risk of acute PE based on Wells’ criteria with positive D-dimer testing and computed tomography pulmonary angiography (CTPA) showing thrombus formation in the left-ascending pulmonary artery.DiscussionAcute PE may present solely with asymptomatic sinus tachycardia in TB spondylodiscitis. This caveat should provide a high index of suspicion to prevent delay in diagnosis and prevention of more sinister complications. Early stratification based on Wells’ criteria for a possible diagnosis of acute PE is proven to be a useful approach in conjunction with clinical features.

An unexpected delivery: pregnancy experience of a paraplegic lady

Introduction:Spinal cord injury (SCI) has increased over the years, and so has the survival. Women with SCI remain fertile and have equal chance of pregnancy.Case presentation:We described a case of a 29-year-old lady with traumatic spinal cord injury (SCI) resultant with paraplegia in 2008, who conceived naturally 2 years after the injury. She only had her antenatal check-up at a low-risk antenatal center throughout her pregnancy and was not referred to specialized obstetric care. She did not appreciate active labor, and unexpectedly had a precipituous labor and gave birth in the bathroom.Discussion:Pregnancy is relatively safe in women with spinal cord injury (SCI). However, disability-related issues can be exaggerated during pregnancy, delivery and post-partum periods. Thus, understanding common issues related to pregnancy in this population is important. Specialized obstetric care with rehabilitation input throughout antenatal and postnatal care is crucial for a good overall outcome of a pregnant woman with SCI.

Coronary vasospasm in intractable autonomic dysreflexia.

Introduction:Coronary vasospasm is a transient sudden vasoconstriction of one of the coronary arteries that can lead to myocardial ischaemia, myocardial infarction, fatal arrhythmia and sudden death. Most patients with coronary spasm have underlying cardiac pathology.Case Presentation:This paper presents a rare case of intractable autonomic dysreflexia in a 36-year-old patient with chronic C5 paraplegia with silent myocardial ischaemia secondary to coronary vasospasm in the absence of underlying cardiac pathology. The MRI perfusion study revealed normal left ventricular contractility and no evidence of coronary artery occlusion.Discussion:This case highlights the cardiac complications associated with paroxysmal heightened sympathetic nervous system and proposes that autonomic dsyreflexia can predisposes to coronary vasospasm via uncontrolled sympathetic nervous system. The disruption of sensory input from the myocardium to the brain in patient with SCI predisposes them to asymptomatic myocardial ischaemia. The challenges in the diagnosis and management of coronary vasospasm associated with autonomic dysreflexia are described.

PO-0840 Parent-reported Pain In Non-verbal Children And Adolescents With Cerebral Palsy

Background and aims This study aimed to (i) determine the prevalence of parent-reported pain among non-verbal children with cerebral palsy (CP), (ii) determine the frequency and intensity of pain and (iii) explore associations with medical, parental and socioeconomic factors. Methods The study was cross-sectional. Participants were parents of non-verbal CP outpatients at University Malaya Medical Centre, Kuala Lumpur and two centres in the surrounding area. Patients were aged 2–19 years. Written informed consent was obtained. The Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD©) Questionnaire and a separate proforma were utilised for assessment of frequency and intensity of pain during the preceeding 4 weeks. Parental psychosocial well being was assessed via the Depression, Anxiety and Stress Scale (DASS-21) and the Multidimensional Scale of Perceived Social Support (MSPSS). Results The response rate was 94%, including 104 children (54 boys, 50 girls). The majority (51%) had GMFCS level V and 65% had spastic quadriplegia. Reported pain was 65%. The most frequent and intense pain was during physiotherapy. Nineteen (18%) reported that their children experienced pain >1 time per day and 10% reported daily pain. Severe pain was reported by 17%. There were no significant factors associated with frequency of pain. Older children (p < 0.05), those with spastic quadriplegia (p < 0.05) and poorer quality of life (p < 0.05) had more intense pain. GMFCS level, gender, co-morbidities, parental psychosocial scores, parental education and income were not significant modifying factors of intensity of pain. Conclusion Recognition of pain in non-verbal CP patients is crucial for holistic management.