Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions: Preventing the Highs and Lows

Pregnancy in women with spinal cord injury is considered high risk because it may exacerbate many of their existing problems, including autonomic dysreflexia, spasms, decubitus ulcers, urinary tract infections and respiratory infections. Due to the relative rarity of spinal cord injury in the general obstetric population, clinicians often lack familiarity of these specific problems and the women themselves are usually more experienced in their own management than their obstetric team. However, studies have demonstrated that pregnancy outcomes are generally good with appropriate and experienced obstetric care. In this review, we examine the available literature and provide advice on pre-conception counselling and the antenatal, intrapartum and postnatal management of pregnant women with spinal cord injury.

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Autonomic dysreflexia associated with cervical spinal cord gliofibroma: case report

BMC Neurology ◽

10.1186/s12883-021-02271-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hiroyuki Mizuno ◽

Fumiaki Honda ◽

Hayato Ikota ◽

Yuhei Yoshimoto

Keyword(s):

Spinal Cord ◽

Cervical Spinal Cord ◽

Spinal Cord Tumor ◽

Autonomic Dysreflexia ◽

Tumor Biopsy ◽

Intramedullary Lesion ◽

First Case ◽

Cord Injury ◽

Paroxysmal Hypertension ◽

Upper And Lower Extremities

Abstract Background Autonomic dysreflexia (AD) is an abnormal reflex of the autonomic nervous system normally observed in patients with spinal cord injury from the sixth thoracic vertebra and above. AD causes various symptoms including paroxysmal hypertension due to stimulus. Here, we report a case of recurrent AD associated with cervical spinal cord tumor. Case presentation The patient was a 57-year-old man. Magnetic resonance imaging revealed an intramedullary lesion in the C2, C6, and high Th12 levels. During the course of treatment, sudden loss of consciousness occurred together with abnormal paroxysmal hypertension, marked facial sweating, left upward conjugate gaze deviation, ankylosis of both upper and lower extremities, and mydriasis. Seizures repeatedly occurred, with symptoms disappearing after approximately 30 min. AD associated with cervical spinal cord tumor was diagnosed. Histological examination by tumor biopsy confirmed the diagnosis of gliofibroma. Radiotherapy was performed targeting the entire brain and spinal cord. The patient died approximately 3 months after treatment was started. Conclusions AD is rarely associated with spinal cord tumor, and this is the first case associated with cervical spinal cord gliofibroma. AD is important to recognize, since immediate and appropriate response is required.

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Clinical Markers May Identify Patients at Risk for Early Parkinson’s Disease Dementia: A Prospective Study

American Journal of Alzheimer s Disease & Other Dementias® ◽

10.1177/15333175211021369 ◽

2021 ◽

Vol 36 ◽

pp. 153331752110213

Author(s):

Anamaria Jurcau ◽

Vharoon Sharma Nunkoo

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Clinical Markers ◽

Pearson Coefficient ◽

Autonomic Dysfunctions ◽

Patients At Risk ◽

A Prospective Study ◽

State Examination

Background: The study aims at identifying features predictive of early onset of dementia in Parkinson’s disease (PD). Methods: 103 non-demented PD patients were evaluated on various scales at baseline and 89 patients at 3-year follow-up. Results: By the end of the study 43.8% of patients developed dementia. The development of dementia was linked to the baseline Mini Mental State Examination score (Pearson coefficient r = .404, p = 0.013), the presence of autonomic dysfunctions (r = −.621, p < 0.001) and insomnia (r = −.526, p = 0.001). A binary logistic regression analysis showed that the development of dementia was correlated strongly with the presence of autonomic dysfunctions (95% CI 2.60 to 52.83, p < 0.001), and insomnia (95% CI 0.60 to 0.95, p = 0.017). Conclusion: Patients with signs of autonomic dysfunction and insomnia are at higher risk for developing dementia and deserve closer monitoring of cognitive symptoms.

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