A 40-year-old Cambodian woman came in by ambulance complaining of whole body stiffness and inability to speak or move her neck. This was her third visit to our emergency department in a week.
Her first visit came after she was involved in a minor motor vehicle crash. She was rear ended, resulting in minor damage to her car. She developed a migraine headache after the crash so she came to our emergency department to make sure she was OK. She was found to have no serious injury and her headache had resolved by the time she left.
The evening before I saw her, she was at Bible study and was reading aloud from the scripture. As she did so, she progressively lost her ability to speak. Her voice became quieter and she had trouble breathing. She then developed stiffness in her neck that spread to her jaw and then her entire body, making her unable to walk. After a few minutes, this resolved but she came to the emergency department to be checked again. She was interviewed and examined by a doctor and sent home, with reassurance.
I saw her on her third visit the following day. Once again, while reading, she developed difficulty breathing and body stiffness. Her family called the ambulance to bring her back to the emergency department.
As I walked into the room, I was very impressed by how miserable she was. She was stiff and shaking from head to toe. She was unable to open her mouth normally or move her neck in any direction. Though she could hardly talk, she was screaming hysterically. Her heart was racing away.
I ordered something to help her relax. I also ordered blood tests to make sure she didn’t have something unusual, like a low blood calcium level, that might explain her muscle rigidity. Fortunately, the blood tests were all normal.
When I went back to check on her, the sedative had worked perfectly to cure her stiffness and inability to speak or move her neck. Her pulse rate had returned to a normal level and she was ready to be discharged. However, she was hesitant to leave for fear she would have the symptoms again at home when she read. I proposed an easy test and asked her to read something.
As soon as she started to read, she freaked out. She started to holler loudly and have the same stiffness and shaking she had when she first arrived. He pulse shot up again as well.
After more time and another round of sedatives, her symptoms again resolved. I was finally able to get her and her very concerned family to see that the only explanation for this was a panic attack and that, with time, she would be able to return to reading again.
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