1/30. An unusual complication during electroejaculation in an individual with tetraplegia.infertility in males is a common problem after spinal cord injury, often requiring interventional methods. In the authors' fertility program they have experienced 4 pregnancies and 3 live births using both electroejaculation (EEJ) and vibratory stimulation techniques. EEJ is a relatively safe procedure with few complications reported in the literature. Here is a case of a 23-year-old with C-6 ASIA A tetraplegia who, while receiving EEJ, developed autonomic dysreflexia that was followed by new onset atrial fibrillation. The patient's cardiac condition required management in the Emergency Department with pharmacologic conversion to a normal sinus rhythm. Although autonomic dysreflexia is a common adverse effect during EEJ, atrial fibrillation has not been previously reported as a complication. It is proposed that the patient's atrial fibrillation developed as a result of cardiac changes induced through autonomic dysreflexia.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/30. 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 = 4keywords = spinal (Clic here for more details about this article) |
3/30. Management of autonomic hyperreflexia with magnesium sulfate during labor in a woman with spinal cord injury.Autonomic hyperreflexia, one of the gravest complications of delivery among women with spinal cord injury, has been treated with spinal or epidural anesthesia but not always successfully. We discovered dramatically beneficial effects of magnesium sulfate on autonomic hyperreflexia during labor in a patient with spinal cord injury at a high level.- - - - - - - - - - ranking = 7keywords = spinal (Clic here for more details about this article) |
4/30. 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 = 4keywords = spinal (Clic here for more details about this article) |
5/30. pregnancy complicated by chronic spinal cord injury and history of autonomic hyperreflexia.BACKGROUND: women with spinal cord injuries are at risk for autonomic hyperreflexia during labor. CASE: A 36-year-old woman, gravida 4, para 2, abortus 1, with a spinal cord injury and a positive antibody screen result had had a previous pregnancy complicated by autonomic hyperreflexia during labor. Autonomic hyperreflexia did not occur during serial amniocenteses and fetal transfusions for isoimmunization or intrapartum. CONCLUSION: Intrauterine procedures and vaginal delivery were accomplished without autonomic hyperreflexia in this pregnancy. Intrauterine procedures and vaginal delivery might be done safely in women with histories of autonomic hyperreflexia.- - - - - - - - - - ranking = 6keywords = spinal (Clic here for more details about this article) |
6/30. 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 = 2keywords = spinal (Clic here for more details about this article) |
7/30. Neuropathic lumbar spondylolisthesis--a rare trigger for posture induced autonomic dysreflexia.STUDY DESIGN: Case report. OBJECTIVES: Description of a rare trigger for autonomic dysreflexia. SETTING: Princess Royal spinal injuries Unit, Sheffield. methods AND RESULTS: A case of Charcot's spine (neuropathic spinal arthropathy) in a woman with a traumatic T5 paraplegia is described. She developed symptoms of autonomic dysreflexia, brought on by changes in posture. The postural variation was attributable to a freely mobile neuropathic spondylolisthesis at the L4/5 level. A laminectomy performed for the implantation of a sacral anterior root stimulator was identified as a causative factor in the development of the neuropathic joint. Surgical stabilisation and fusion resulted in amelioration of her symptoms. CONCLUSION: Neuropathic spine is a rare cause of autonomic dysreflexia that should be considered when other more common factors have been excluded. The development of Charcot's spine in the spinal cord injured population is facilitated by surgical procedures involving the vertebrae.- - - - - - - - - - ranking = 2keywords = spinal (Clic here for more details about this article) |
8/30. autonomic dysreflexia associated with transient aphasia.STUDY DESIGN: Case report of autonomic dysreflexia presenting with transient aphasia in a subject with C4 tetraplegia. OBJECTIVES: To report a rare case of autonomic dysreflexia. SETTING: rehabilitation Service, The ohio State University, USA. CASE REPORT: A 21-year-old man with a C4 spinal cord injury (ASIA B) developed aphasia associated with autonomic dysreflexia. He was treated with an adrenergic blocking agent. CONCLUSION: autonomic dysreflexia manifested by a transient aphasia and seizures is uncommon.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
9/30. autonomic dysreflexia in multiple sclerosis.BACKGROUND: Although autonomic dysreflexia (AD) is well documented in the spinal cord injury (SCI) population, its occurrence in persons with multiple sclerosis (MS) is not. A dense multiple sclerotic lesion in the spinal cord at or above the sixth thoracic level can cause interruption of descending inhibitory impulses and thus result in AD. A patient with MS presented to our facility with classic signs and symptoms of AD. We believe that lack of knowledge about the risks for this condition in MS led to a delay in diagnosis. methods: Case report illustrates AD in a person with MS. A convenience survey was conducted among clinicians who provide care to people with MS. The survey looked at both awareness of, and experience with, AD in MS. RESULTS: Forty-five percent of the respondents indicated they were not aware of the potential risk for AD among MS patients. Only 10% indicated they were aware of MS patients in their practice who had experienced AD. CONCLUSION: Although AD is probably less common in MS than in SCI, this case does not appear to be unique. knowledge of this potential life-threatening complication of MS seems to be limited.- - - - - - - - - - ranking = 2keywords = spinal (Clic here for more details about this article) |
10/30. 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 = 5keywords = spinal (Clic here for more details about this article) |
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