Precision diagnostics in bronchiectasis: current advances in imaging, microbiology, biomarkers, and digital health.

Patients who have experienced traumatic spinal cord injury (TSCI) may develop various comorbidities and secondary health conditions [], among which spasticity is the most prevalent []. Spasticity, including hyperreflexia as a component, does not manifest immediately after the injury but rather emerges gradually over time []. Moreover, spasticity can significantly impact the daily activities of individuals with SCI and their families, leading to long‐term debilitation [, ]. Moreover, spasticity is intimately linked with contracture, which can manifest weeks or months after the initial onset of spasticity []. Prompt intervention for spasticity is essential to prevent the progression of contracture [], as its severity and complexity markedly escalate once contracture is established. Various treatment options, including antispasmodics and physical therapies, offer the opportunity for symptomatic relief. In managing diseases, particularly intractable symptoms, investigating the underlying etiology is crucial []. However, in patients presenting with severe symptoms or some already known difficult diseases [, ], prioritizing rapid symptom alleviation may be more critical. This case report presents a clinical scenario that illustrates the potential consequences of delayed symptomatic intervention during prolonged etiological investigation in a patient with sudden unilateral spasticity exacerbation following a fall. Rather than establishing a general principle, this case raises a clinically relevant question: in selected patients with severe, functionally limiting spasticity where initial diagnostic workup is unrevealing, could earlier targeted symptomatic treatment—administered in parallel with ongoing monitoring—have prevented secondary complications? We present this case to stimulate discussion on this under‐explored clinical dilemma. Written informed consent was obtained for publication of the present study. A 26‐year‐old man had a 6‐year history of TSCI following a motorcycle accident. At the time of the accident, he was struck by a passenger car while riding a motorcycle. He was diagnosed with a burst fracture of T7‐8 based on the outpatient computed tomography (CT) and received emergency surgeries for spinal instrumentation. Postoperatively, he was unable to control his lower limb or maintain core balance. Spasticity and pain emerged 1 year after the injury, manifested as lower limb spasticity, but were controlled by muscle stretching, strength training, and antispastic medication. Following 6 years of gradual rehabilitation, and up until 3 months prior, he was able to perform self‐care in daily life using a sports wheelchair and his strong upper limb. He also attempted standing and walking training with the help of orthoses. Prior to the fall that occurred 3 months earlier, the patient's medical records documented an American Spinal Injury Association (ASIA) Impairment Scale (AIS) level [] of D (recorded as C after the motorcycle accident) and Manual Muscle Test (MMT) scores of grade 4 for flexion in the primary muscle groups. The patient reported that the preservation of function in these muscles enabled attempts at standing and short walks with orthoses. Unfortunately, he fell from his wheelchair that affected his right hip 3 months ago. He experienced a sudden, marked increase in abdominal and right lower limb muscle tone, and he reported loss of voluntary control of the right lower limb, particularly during attempted hip flexion, which triggered involuntary spasticity (Figure  illustrates the patient's abnormalities identified during the physical examination; the dynamic abnormalities exhibited by the patient during the physical examination are demonstrated in Video ). These symptoms persisted without improvement, even though medical records indicated that adequate antispastic medications, including both anticholinergic and benzodiazepine drugs, had been prescribed by his local physician. The patient felt depressed about losing the functional gains he had worked hard to achieve, as these symptoms diminished his quality of life. The patient visited our rehabilitation department (the largest SCI center in a province in Southwest China) 3 months after the fall, in June 2023. His Hamilton Depression Rating Scale (HAMD) score was 18, indicating moderate depression []. His right lower limb continued to twitch upon any external contact, especially upon active his flexion; the lower limb showed continued extension posture (Video ). A comprehensive neurological assessment indicated hyperreflexia in the right patellar and Achilles tendons. Sensory evaluation demonstrated preservation of light touch and pinprick sensations, albeit with bilateral diminution below the T7 dermatome, and no asymmetry was observed. Pain and temperature assessments revealed no abnormal sensations. The Modified Ashworth Scale (MAS) was rated as 3 for the right hip flexors and 2 for the right knee extensors, while the left lower limb exhib