1/12. Early autonomic dysreflexia.INTRODUCTION: During the stage of spinal shock the conventional view is that autonomic activity is abolished. Here, evidence is presented that autonomic activity is still present. patients: Four patients with acute cord transactions are presented: one new case and three from the literature. DEFINITIONS: The definitions of spinal shock and autonomic dysreflexia are given. methods: All four cases showed acute autonomic dysreflexia between 7 and 31 days after acute cord transection at a stage when the tendon reflexes were abolished. RESULTS: Two cases showed a severe rise in blood pressure; the two earlier cases, before blood pressure was routinely recorded, profuse sweating. In two cases autonomic dysreflexia was obtained when the bladder was overdistended with 1000 ml and 1600 ml. In the other two cases it occurred in response to traumatic catheterisation. This was found when supramaximal stimuli were applied. It has not been recorded routinely as, with modern management, the bladder does not get overdistended or traumatised. DISCUSSION: Other evidence, the blood pressure, and urethral tone is presented to show that sympathetic reflex activity of the cord is not abolished during spinal shock. CLINICAL SIGNIFICANCE: The clinical importance of this is that autonomic dysreflexia can be seen at an early stage and it should be considered in the differential diagnosis of a sick patient immediately after spinal injury.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/12. catecholamines response of high performance wheelchair athletes at rest and during exercise with autonomic dysreflexia.autonomic dysreflexia presents a special situation in high-lesion spinal cord injury, however, intentionally or self-induced autonomic dysreflexia directly before or during competition to increase performance, so called 'boosting', is also being reported. In order to examine the influence of autonomic dysreflexia on plasma catecholamines, cardiocirculatory and metabolic parameters, 6 spinal cord injured wheelchair athletes with high-level lesions underwent wheelchair ergometry without (ST1) and with (ST2) autonomic dysreflexia. At the point of exhaustion significantly higher values for norepinephrine and epinephrine were observed in ST2 than in ST1. During autonomic dysreflexia a significantly higher peak performance (77.5 vs. 72.5 watt), higher peak heart rate (161 vs. 149 x min(-1)), and peak oxygen consumption (1.96 vs. 1.85 l x min(-1)), with comparable peak lactate (7.11 vs. 7.00 mmol x l(-1)) were reached on average. The blood pressure values in ST2 were partially hypertensive and higher than in ST1. In conclusion, autonomic dysreflexia, as a sympathetic spinal reflex, leads to a higher release of catecholamines during exercise. This results in higher peak performance, peak heart rate, peak oxygen consumption, and higher blood pressure values. The peak lactate, as an indicator of the anaerobic lactate metabolism, was unchanged. However, autonomic dysreflexia presents an unpredictable risk, caused predominantly by hypertensive blood pressure values, for high-lesion spinal cord injured persons at rest and more so during exercise; it is seen as a prohibited manipulation by the doping guidelines of the International Paralympic Committee.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/12. autonomic dysreflexia and foot and ankle surgery.autonomic dysreflexia is a syndrome of massive imbalance of reflex sympathetic discharge occurring in patients with spinal cord injury with a lesion above the splanchnic outflow (Thoracic 6). autonomic dysreflexia is characterized by a sudden and severe rise in blood pressure and is potentially life threatening. Because the onset of this entity is rapid and the potential morbidity is severe, it is important for those caring for spinal cord injury patients to be aware of this syndrome. The paper presents a review of the literature, and familiarizes one with the diagnosis, pathophysiology, and treatment. Two illustrative case reports are also presented.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
4/12. Spinal cord injury medicine. 2. Medical complications after spinal cord injury: Identification and management.This is a self-directed learning module that reviews medical complications associated with spinal cord injury (SCI). It is part of a chapter on SCI medicine in the Self-Directed Physiatric Educational Program for practitioners and trainees in physical medicine and rehabilitation. This article includes discussion of common medical complications that impact rehabilitation and long-term follow-up for individuals with SCI. Issues addressed include the rehabilitation approach to SCI individuals with pressure ulcers, unilateral lower-extremity swelling (deep venous thrombosis, heterotopic ossification, fractures), along with the pathophysiology, assessment, and treatment of spasticity, autonomic dysreflexia, orthostatic hypotension, and pain. overall ARTICLE OBJECTIVE: To describe diagnostic and treatment approaches for medical complications common to individuals with SCI.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
5/12. Management of life-threatening autonomic hyper-reflexia using magnesium sulphate in a patient with a high spinal cord injury in the intensive care unit.We report the successful use of i.v. magnesium sulphate to control life-threatening autonomic hyper-reflexia associated with chronic spinal cord injury in the intensive care environment. A 37-yr-old, male was admitted to the intensive care unit with a diagnosis of septic shock and acute renal failure secondary to pyelonephritis. He had been found unresponsive at home following a 2-day history of pyrexia and purulent discharge from his suprapubic catheter. He had sustained a T5 spinal cord transection 20 yr previously. Initial management included assisted ventilation, fluid resuscitation, vasopressor support, and continuous veno-venous haemofiltration. The sepsis was treated with antibiotic therapy and percutaneous nephrostomy drainage of the pyonephrosis. On the fifth day, the patient developed profuse diarrhoea. This was associated with paroxysms of systemic hypertension and diaphoresis, his arterial pressure rising on occasion to 240/140 mm Hg. A diagnosis of autonomic hyper-reflexia was made and a bolus dose of magnesium sulphate 5 g was administered over 15 min followed by an infusion of 1-2 g h(-1). There was an almost immediate decrease in the severity and frequency of the hypertensive episodes. There were no adverse cardiac effects associated with the administration of magnesium, only a slight decrease in minute ventilation as the plasma level approached the upper end of the therapeutic range (2-4 mmol litre(-1)). In view of the beneficial effects observed in this case we advocate further research into the use of magnesium sulphate in the treatment or prevention of autonomic hyper-reflexia secondary to chronic spinal cord injury in the intensive care unit.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
6/12. autonomic dysreflexia: a plastic surgery primer.Plastic surgeons are integral to the management team for patients with spinal cord injuries, with responsibilities including pressure sore management and upper extremity reconstruction. Injury to the spinal cord profoundly disrupts the body's ability to maintain homeostasis. In particular, the autonomic system can become unregulated, resulting in a massive sympathetic discharge called autonomic dysreflexia. autonomic dysreflexia occurs in the majority of patients with injuries above the sixth thoracic vertebra and causes sudden, severe hypertension. If left untreated, autonomic dysreflexia can result in stroke or death. Because this syndrome causes morbidity and mortality, it is crucial for plastic surgeons to be able to recognize and treat autonomic dysreflexia. This article reviews the etiology, symptoms, and treatment of this syndrome.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
7/12. autonomic dysreflexia after intramuscular injection in traumatic tetraplegia: a case report.autonomic dysreflexia is a syndrome of massive imbalance of reflex sympathetic discharge occurring in patients with spinal cord lesion above the splanchnic outflow (T6). It is characterized by a sudden onset and severe increase in blood pressure and is potentially life threatening. The most common causes are bladder and rectum distention. In this case study, we report an autonomic dysreflexia case that developed after intramuscular injection in a 29-yr-old tetraplegic patient with C5 American Spinal Injury association grade A lesion. After careful scrutiny of English literature, this clinical manifestation seems to be an unusual event.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
8/12. autonomic dysreflexia manifested by severe hypertension.BACKGROUND: autonomic dysreflexia (AD) is a sudden and exaggerated autonomic response to stimuli in patients with spinal cord injuries or dysfunction above the splanchnic sympathetic outflow (T5-T6). hypertension is a relatively common manifestation of AD. CASE REPORT: We describe a case of a young man with T4-T6 spinal cord tumor who developed severe hypertension before any other clinical feature of AD, leading to a subsequent clinical evaluation and the correct diagnosis. Treatment with labetalol was only partially successful in controlling the elevated blood pressure. hypertension resolved immediately after bladder decompression. CONCLUSIONS: AD manifested by severe hypertension is uncommon. Bladder decompression appears to be safe and effective for management of hypertension in patients with AD.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
9/12. Ambulatory blood pressure monitoring in persons with chronic spinal cord injury.BACKGROUND: hypertension alone or in the presence of autonomic dysreflexia (AD) may be underdiagnosed and consequently mismanaged in people with chronic spinal cord injury (SCI). blood pressure (BP) derangements caused by AD are characterized by labile BP, in addition to episodic hypertension. Consequently, random BP readings often prove insufficient, which makes traditional outpatient evaluation and management suboptimal. Because elevated BP is common to essential hypertension (EH) and AD, distinction between the 2 entities proves challenging. The distinction is imperative because the treatments differ. Conventional BP monitoring in the office may miss labile BP patterns and episodic BP elevations. Ambulatory BP monitoring (ABPM) is used in the general population to improve the diagnosis and management of hypertension. ABPM provides the average BP level, circadian rhythm, and short-term BP variability. There is a paucity of ABPM studies in persons with SCI. OBJECTIVE: To explore the role of ABPM in individuals with SCI. methods: This study is a case description and detailed analysis of the use of ambulatory blood pressure monitoring (ABPM) in 3 persons with chronic SCI. RESULTS: Three cases were identified in which the diagnosis of autonomic dysreflexia, exaggerated blood pressure variability and disruption of circadian blood pressure pattern was delayed using conventional blood pressure evaluation. ABPM aided in diagnosis by providing the average blood pressure level, circadian rhythm and short-term BP variability. CONCLUSION: Because conventional office BP monitoring may miss labile BP patterns and episodic BP elevations, it is limited in the SCI population. ABPM may improve the outpatient management of blood pressure abnormalities in individuals with chronic SCI by clarifying mechanisms and patterns of BP in this patient population.- - - - - - - - - - ranking = 3.6666666666667keywords = pressure (Clic here for more details about this article) |
10/12. Intracerebral hemorrhage secondary to autonomic dysreflexia in a young person with incomplete C8 tetraplegia: A case report.Intracerebral hemorrhage is an unusual complication of autonomic dysreflexia and can be fatal if massive bleeding occurs with brain herniation. We report the case of a man in his midthirties with incomplete tetraplegia who suffered right putaminal hemorrhage during an episode of autonomic dysreflexia. Prompt recognition and removal of the triggering factors of autonomic dysreflexia quickly brought his blood pressure under control and the patient had a favorable functional outcome after rehabilitation. A review of the literature suggests that the location of hemorrhage in autonomic dysreflexia-induced cases is similar to that in the general population. The most common triggering factors are bladder distension in men and labor induction in women. Hemorrhagic stroke can also occur in patients with incomplete spinal cord injury (SCI) who develop autonomic dysreflexia. The role of sympathetic skin response examination is also discussed. This life-threatening complication should be kept in mind in the case of people with SCI.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
| | Next -> |