Autonomic dysreflexia: an important cardiovascular complication in spinal cord injury patients.
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Autonomic dysreflexia (AD) is a life-threatening complication of spinal cord injury (SCI) at T6 or above that results in an uncontrolled sympathetic discharge in response to noxious stimuli. It is a symptom complex characterized by a lethal rise in blood pressure with dangerous consequences. Autonomic dysreflexia is often secondary to urological, gastrointestinal, or gynecological problems or manipulations. Early recognition and prompt treatment of AD is vital to prevent complications, including death. Its management starts primarily with its prevention. Easy measures can avoid this high risk event, and physicians should be aware of the simple procedures and the possible treatment cascade that could be undertaken. The purpose of this systematic review is to review the clinical data on the mechanisms and pathophysiology of this condition and the clinical evidence about the various strategies currently used to prevent and manage AD in the SCI population; and to improve awareness of AD among cardiologists, family physicians and medical personnel in the emergency department. (+info)
Cardiovascular complications of spinal cord injury.
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Autonomic dysreflexia: recognizing a common serious condition in patients with spinal cord injury.
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OBJECTIVE: To raise family physicians' awareness of autonomic dysreflexia (AD) in patients with spinal cord injury (SCI) and to provide some suggestions for intervention. SOURCES OF INFORMATION: MEDLINE was searched from 1970 to July 2011 using the terms autonomic dysreflexia and spinal cord injury with family medicine or primary care. Other relevant guidelines and resources were reviewed and used. MAIN MESSAGE: Family physicians often lack confidence in treating patients with SCI, see them as complex and time-consuming, and feel undertrained to meet their needs. Family physicians provide a vital component of the health care of such patients, and understanding of the unique medical conditions related to SCI is important. Autonomic dysreflexia is an important, common, and potentially serious condition with which many family physicians are unfamiliar. This article will review the signs and symptoms of AD and offer some acute management options and preventive strategies for family physicians. CONCLUSION: Family physicians should be aware of which patients with SCI are susceptible to AD and monitor those affected by it. Outlined is an approach to acute management. Family physicians play a pivotal role in prevention of AD through education (of the patient and other health care providers) and incorporation of strategies such as appropriate bladder, bowel, and skin care practices and warnings and management plans in the medical chart. (+info)
Cerebral hemorrhage due to posterior reversible encephalopathy syndrome associated with autonomic dysreflexia in a spinal cord injury patient.
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A 37-year-old man with C4-5 spinal cord injury (SCI) presented with abnormally high blood pressure after vesicocutaneous catheter exchange and was treated with antihypertensive agents. Two weeks later, he developed headache and visual disturbance, and presented with fluctuating blood pressure. Multiple subcortical hemorrhages in the left occipital and right frontal lobes occurred on the next day, and he died of increased intracranial pressure 3 weeks later. Based on the symptoms and computed tomography findings, the retrospective diagnosis was posterior reversible encephalopathy syndrome (PRES) due to autonomic dysreflexia (AD). AD occurs frequently in patients with quadriplegia and high paraplegia by distention of the bladder and bowel. PRES secondary to AD is very rare, but we must always be aware of this life-threatening complication in SCI patients. (+info)
Viscerosympathetic reflexes in human spinal cord injury: relationships between detrusor pressure, blood pressure and skin blood flow during bladder distension.
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Hypertensive intracerebral hemorrhage due to autonomic dysreflexia in a young man with cervical cord injury.
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The author reports the case of a 36 year old man with cervical cord injury in whom autonomic dysreflexia developed into intracerebral hemorrhage during inpatient rehabilitation. This patient showed complete quadriplegia (motor below C6 and sensory below C7) due to fracture of the 6th cervical vertebra. An indwelling urethral catheter had been inserted into the bladder for 3 months, diminishing bladder expansiveness. Bladder capacity decreased to 200 ml and the patient frequently experienced headaches whenever his bladder was full.To obtain smoother urine flow, a supra-pubic cystostomy was performed. The headaches were temporarily cured, but soon relapsed with extreme increases in blood pressure, representing typical symptoms of autonomic dysreflexia. However, no potential triggers were identified or removed, and lack of blood pressure management led to left putaminal hemorrhage. Despite operative treatment, the right upper extremity showed progressive increases in muscle tonus and finally formed a frozen shoulder with elbow flexion contracture. Two factors contributed to this serious complication: first, autonomic dysreflexia triggered by minor malfunction and/or irritation from the cystostomy catheter; and second, the medical staff lacked sufficient experience in and knowledge about the management of autonomic dysreflexia.It is of the utmost importance for medical staff engaging in rehabilitation of spinal patients to share information regarding triggers of autonomic dysreflexia and to be thorough in ensuring proper medical management. (+info)
Atypical autonomic dysreflexia during robotic-assisted body weight supported treadmill training in an individual with motor incomplete spinal cord injury.
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