Document Type
Clinical Case Reports
Date of Poster
2020
Date of Submission
May 2020
Abstract
Abstract Title: What’s that Beeping Sound? A Case Report
Ellie Balakhanlou, Medical Doctor - Medical Resident, Virginia Commonwealth University School of Medicine (Role: Presenting Author)
Olivier Rolin, Medical Doctor – Assistant Professor, Virginia Commonwealth University School of Medicine (Role: Corresponding Author)
Eugenio Monasterio, Medical Doctor – Assistant Professor, Virginia Commonwealth University School of Medicine (Role: Corresponding Author)
Disclosure: None. Setting: Outpatient pediatric clinic Patient: A 21 year old female with spastic quadriplegic cerebral palsy (CP) with an intrathecal baclofen (ITB) pump
Case Description:
The patient presented with concerns of intermittent beeping sounds from her pump. She does not endorse any new weakness or spasticity. She notes the sound alarms for 10 minutes with long periods of silence.
Assessment:
Neurological exam was unremarkable except for sustained clonus on the right foot, which was not present at usual baseline. Interrogation of her Medtronic SynchroMed™ II showed it was replaced 3 months prior with a low reservoir alarm date in 6 months. The reservoir volume was 16.7 mL and no recent alerts were recorded. Abdominal x-ray was unremarkable for discontinuity or kinking of the pump catheter. Pump was programmed to deliver a 20-mcg bolus over 5 minutes. On reassessment in one hour, she was found to have decreased muscle tone and resolved clonus.
Discussion:
Given benign X-ray findings and the response to the bolus, we concluded that pump was functioning appropriately and the catheter was in continuity. We discussed our case with a representative from Medtronic who suggested the alarm may be coming from her recently explanted pump, which the patient had indeed kept. The patient was then discharged back home where she found her explanted pump alarming on her night table.
Conclusion:
ITB administration is a useful and well-established treatment of severe spasticity. The pump alarm alerts when pump volume is below the programmed low reservoir alarm volume or if it needs to be replaced. We report a case in which the patient mistakenly associated her removed pump alarm with her current implanted pump. This case demonstrates the importance of educating patients regarding the different alarm sounds, reasons why the pump may alarm, and disabling explanted pumps (if kept).
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