scholarly journals Brainstem Haemorrhage due to Autonomic Dysreflexia in a Person with C6 Tetraplegia

2015 ◽  
Vol 26 (4) ◽  
pp. 114-116
Author(s):  
Raji Thomas ◽  
Swapna Patil
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intracerebral Haemorrhage ◽  
Preventive Measures ◽  
Organ Damage ◽  
Autonomic Dysreflexia ◽  
Brain Herniation ◽  
Treatment Methods ◽  
Cord Injury

Abstract Autonomic dysreflexia is an important clinical complication occurring in patients with high levels of spinal cord injury. If untreated, the acute rise in blood pressure can cause end organ damage, including intracerebral haemorrhage. Though unusual, it can be fatal with large haemorrhages causing brain herniation syndromes. Here we report the case of a patient with C6 complete tetraplegia patient who developed brainstem haemorrhage during an episode of autonomic dysreflexia. The pathophysiology and treatment methods of this condition are discussed, highlighting the importance of preventive measures to avoid the same.

Autonomic Dysreflexia

2017 ◽  
Author(s):  
Koffi Kla
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Syndrome ◽  
Autonomic Dysreflexia ◽  
Antihypertensive Medications ◽  
Blood Pressure Elevation ◽  
Sudden Rise ◽  
Cord Injury ◽  
Trigger Stimulus

Autonomic dysreflexia (AD), a potentially emergent clinical syndrome that can occur in patients with spinal cord injury, is characterized by a sudden rise in blood pressure caused by uncontrolled sympathetic activation of the autonomic system below the level of the lesion. When caring for spinal cord injury (SCI) patients, a pretreatment plan should be in place if an AD episode occurs. Physical manifestations of an AD episode can include headache, flushing, and diaphoresis above the lesion. Treatment should be aimed at identifying and eliminating the trigger stimulus and must be prompt to avoid serious complications of blood pressure elevation such as seizures, intracranial hemorrhage, myocardial infarction, or even death. When nonpharmacological measures fail, quick-onset, short-acting antihypertensive medications should be given to lower blood pressure.

Autonomic dysreflexia during sperm retrieval in spinal cord injury: influence of lesion level and sildenafil citrate

2005 ◽  
Vol 99 (1) ◽  
pp. 53-58 ◽  
Author(s):  
A. William Sheel ◽  
Andrei V. Krassioukov ◽  
J. Timothy Inglis ◽  
Stacy L. Elliott
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Heart Rate ◽  
Spinal Cord Injury ◽  
Autonomic Dysreflexia ◽  
Sildenafil Citrate ◽  
Vibratory Stimulation ◽  
Arterial Blood ◽  
Cord Injury ◽  
Penile Vibratory Stimulation

Autonomic dysreflexia (AD) can occur during penile vibratory stimulation in men with spinal cord injury, but this is variable, and the association with lesion level is unclear. The purpose of this study was to characterize the cardiovascular responses to penile vibratory stimulation in men with spinal cord injury. We hypothesized that those with cervical injuries would demonstrate a greater degree of AD compared with men with thoracic injuries. We also questioned whether the rise in blood pressure could be attenuated by sildenafil citrate. Participants were classified as having cervical ( n = 8) or thoracic ( n = 5) injuries. While in a supine position, subjects were instrumented with an ECG, and arterial blood pressure was determined beat by beat. Subjects reported to the laboratory twice and received an oral dose of sildenafil citrate (25–100 mg) or no medication. Penile vibratory stimulation was performed using a handheld vibrator to the point of ejaculation. At ejaculation during the nonmedicated trials, the cervical group had a significant decrease in heart rate (−5–10 beats/min) and increase in mean arterial blood pressure (+70–90 mmHg) relative to resting conditions, whereas the thoracic group had significant increases in both heart rate (+8–15 beats/min) and mean arterial pressure (+25–30 mmHg). Sildenafil citrate had no effect on the change in heart rate or mean arterial pressure in either group. In summary, men with cervical injuries had more pronounced AD during penile vibratory stimulation than men with thoracic injuries. Administration of sildenafil citrate had no effect on heart rate or blood pressure during penile vibratory stimulation in men with spinal cord injury.

scholarly journals The Blood Pressure Pendulum following Spinal Cord Injury: Implications for Vascular Cognitive Impairment

2019 ◽  
Vol 20 (10) ◽  
pp. 2464 ◽  
Author(s):  
Rahul Sachdeva ◽  
Tom E. Nightingale ◽  
Andrei V. Krassioukov
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cognitive Impairment ◽  
Systemic Blood Pressure ◽  
Vascular Cognitive Impairment ◽  
Convincing Evidence ◽  
Autonomic Dysreflexia ◽  
Cord Injury ◽  
Upper Thoracic

Cognitive impairment following spinal cord injury (SCI) has received considerable attention in recent years. Among the various systemic effects of SCI that contribute towards cognitive decline in this population, cardiovascular dysfunction is arguably one of the most significant. The majority of individuals with a cervical or upper-thoracic SCI commonly experience conditions called orthostatic hypotension and autonomic dysreflexia, which are characterized by dangerous fluctuations in systemic blood pressure (BP). Herein, we review the potential impact of extreme BP lability on vascular cognitive impairment (VCI) in individuals with SCI. Albeit preliminary in the SCI population, there is convincing evidence that chronic hypotension and hypertension in able-bodied individuals results in devastating impairments in cerebrovascular health, leading to VCI. We discuss the pertinent literature, and while drawing mechanistic comparisons between able-bodied cohorts and individuals with SCI, we emphasize the need for additional research to elucidate the mechanisms of cognitive impairment specific to the SCI population. Lastly, we highlight the current and potential future therapies to manage and treat BP instability, thereby possibly mitigating VCI in the SCI population.

scholarly journals Prevalence of Autonomic Dysreflexia in Patients with Spinal Cord Injury above T6

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Eun Sun Lee ◽  
Min Cheol Joo
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Heart Rate ◽  
Spinal Cord Injury ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Autonomic Dysreflexia ◽  
Therapeutic Interventions ◽  
Pressure Monitoring ◽  
Cord Injury

Objective. To investigate the prevalence of autonomic dysreflexia (AD) using ambulatory blood pressure monitoring (ABPM) and the autonomic dysfunction following spinal cord injury (ADFSCI) questionnaire in patients with spinal cord injury (SCI) above T6.Methods. Twenty-eight patients diagnosed with SCI above T6 were enrolled. ABPM and ADFSCI were utilized to assess AD. Using ABPM, systolic blood pressure (SBP), diastolic blood pressure, and heart rate (HR) were measured at 30-minute intervals. AD was defined as SBP 20 mmHg higher than basal SBP, and the number of AD events was counted. The ADFSCI questionnaire evaluates the severity and frequency of the AD symptoms.Results. According to the ABPM, AD occurred in 26 patients and AD events occurred5.8±4.7times. Average daytime and nighttime SBP were119.9±18.8 mmHg and123.8±21.2 mmHg, respectively, and the nighttime mean SBP appeared to be 4 mmHg higher than daytime mean SBP. These findings suggest the loss of nocturnal BP dipping in SCI patients. ADFSCI results revealed that 16 of the patients evaluated were symptomatic while 12 were asymptomatic.Conclusion. AD following SCI above T6 was highly prevalent and several patients seemed asymptomatic. These results suggest the necessity of proper diagnostic and therapeutic interventions for managing AD.

scholarly journals Blood pressure and age associated with silent autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury

Spinal Cord ◽  
2012 ◽  
Vol 51 (5) ◽  
pp. 401-405 ◽  
Author(s):  
Y-H Huang ◽  
L-I Bih ◽  
J-M Liao ◽  
S-L Chen ◽  
L-W Chou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Autonomic Dysreflexia ◽  
Cord Injury

Cardiovascular responses to vaginocervical stimulation in the spinal cord-transected rat

1997 ◽  
Vol 273 (4) ◽  
pp. R1361-R1366 ◽  
Author(s):  
Giorgio R. Sansone ◽  
Ralph Bianca ◽  
Rafael Cueva-Rolón ◽  
Lisbeth E. Gómez ◽  
Barry R. Komisaruk
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Heart Rate ◽  
Spinal Cord Injury ◽  
Cardiovascular Responses ◽  
Spinal Cord Transection ◽  
Autonomic Dysreflexia ◽  
Control Group ◽  
Cord Injury ◽  
Sh Group

The present study ascertained whether increases in heart rate (HR) and systolic blood pressure (SBP) produced by vaginocervical stimulation (VS; 500 g force) persist in the unanesthetized rat after chronic spinal cord transection at selected levels. Three groups were used: spinal cord transection at T7 ( n = 10) or L5 ( n = 10) or a sham-operated control group (Sh, n = 10). In the Sh group, VS increased significantly both HR, by 95 ± 14.3 beats/min (bpm) (22 ± 3.7% above baseline), and BP, by 37 ± 5.7 mmHg (37 ± 7.7% above baseline), confirming earlier findings. In the T7 group, VS significantly decreased HR by 107 ± 21.4 bpm (27 ± 4.1% below baseline) and increased BP by 41.3 ± 12.9 mmHg (32 ± 8.3% above baseline). In response to VS, HR increased in every rat in the Sh group and decreased in every rat in the T7 group. In the L5 group, VS failed to significantly affect HR or BP. In the present study, specific levels of spinal cord transection produced differential HR and BP responses to VS in the rat. A model is presented addressing the component responses of autonomic dysreflexia that can occur, contingent on the level of spinal cord injury, in women during parturition or sexual intercourse.

Medical emergency: rash, headache and spinal cord injury

2021 ◽  
Vol 14 (4) ◽  
pp. e238285
Author(s):  
Tom Wells
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Home Blood Pressure ◽  
Autonomic Dysreflexia ◽  
Medical Emergency ◽  
Cord Injury ◽  
History Of ◽  
Patient Partnership ◽  
Key Aspects

A 49-year-old consultant medical oncologist, with a medical history of complete T5 spinal cord injury (March 1992) and long-term paralysis from the chest down, presented with shingles affecting the T7 dermatome. He also had a dull frontal headache, a feeling of agitation and increased blood pressure of 135/90 on a home blood pressure machine (higher than his usual blood pressure of 90/70). Having been taught about autonomic dysreflexia at the time of his initial spinal cord injury, he self-diagnosed autonomic dysreflexia caused by the noxious stimulus of shingles below his level of spinal cord injury. He self-administered a nifedipine 5 mg sublingual capsule to decrease his blood pressure before urgently seeing his general practitioner. Treatment of the shingles with acyclovir and analgesia successfully managed the problem and avoided hospital admission. This case highlights key aspects in treating autonomic dysreflexia and the value of doctor–patient partnership in doing so.

scholarly journals Postprandial Hypotension and Spinal Cord Injury

2021 ◽  
Vol 10 (7) ◽  
pp. 1417
Author(s):  
Rikke Middelhede Hansen ◽  
Klaus Krogh ◽  
Joan Sundby ◽  
Andrei Krassioukov ◽  
Ellen Merete Hagen
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cardiovascular Mortality ◽  
Blood Pressure Measurement ◽  
Ambulatory Blood Pressure Measurement ◽  
Postprandial Hypotension ◽  
Cord Injury ◽  
Time Since Injury ◽  
Median Change

Postprandial hypotension (PPH) is defined as a fall of ≥20 mmHg in systolic blood pressure (SBP) or a SBP of <90 mmHg after having been >100 mmHg before the meal within two hours after a meal. The prevalence of PPH among persons with spinal cord injury (SCI) is unknown. Ambulatory blood pressure measurement was performed in 158 persons with SCI, 109 men, median age was 59.1 years (min.:13.2; max.: 86.2). In total, 78 persons (49.4%) had PPH after 114 out of 449 meals (25.4%). The median change in SBP during PPH was −28 mmHg (min.: −87; max.: −15 mmHg) and 96% of the PPH episodes were asymptomatic. The occurrence of PPH was correlated to older age (p = 0.001), level of injury (p = 0.023), and complete SCI (p = 0.000), but not, gender or time since injury. Further studies are needed to elucidate if PPH contributes to the increased cardiovascular mortality in the SCI population.

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