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Spinal injuries
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Autonomic dysreflexia is a potentially dangerous condition, caused by aberrant responses to visceral stimuli. It is seen with lesions above the mid-thoracic level and results from the loss of the normal descending inhibition of spinal sympathetic reflexes. A bladder infection, development of a pressure sore or even an episode of constipation might trigger a sudden, severe bout of sweating and hypertension, with the potential of causing a cerebral haemorrhage.
Considerations for the Focused Neuro-Urologic History and Physical Exam
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Laura L. Giusto, Patricia M. Zahner, Howard B. Goldman
Additional questions should be asked to determine if the patient exhibits signs or symptoms of autonomic dysreflexia such as hypertension, reflexive bradycardia, diaphoresis, facial flushing, altered mental status, and headache.
Neurourology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Autonomic dysreflexia is a life-threatening emergency which can occur in patients with spinal cord injuries (SCI) at or above T6. There is massive sympathetic discharge of the distal autonomous cord (i.e., below the level of the spinal cord injury) secondary to specific stimulus. Ordinarily the reflexes would be inhibited by output from the medulla but in SCI this does not happen and leads to autonomic dysreflexia.
Sexual health counselling in patients with spinal cord injury: Health care professionals’ perspectives
Published in The Journal of Spinal Cord Medicine, 2022
Mariam Rassem, Muhammad Siddiqui, Shane Wunder, Keren Ganshorn, Jacqueline Kraushaar
Some health care providers may feel sexual health discussions are not a primary concern in the inpatient setting when more pressing injury complications are being addressed and consider this as more of an outpatient or community concern.13 However, autonomic dysreflexia is an acute, potentially life-threatening medical concern that often arises in the inpatient setting and can result from sexual activity.14 If improper or insufficient education is provided for this, patients may have complications at home. This highlights one example of the importance of the continuum of sexual health care from inpatient to outpatient settings. Another major reason sexual health should be discussed within the inpatient setting is that patients often have unspoken fears about their ability to be sexual or have a biological child15 and this should be addressed positively in an inpatient setting without the presumption that patients are only focusing on immediate medical needs. Optimal timing of these discussions remains to be determined and is worthy of further study.2
Takotsubo cardiomyopathy in a chronic spinal cord injury patient with autonomic dysreflexia: A case report
Published in The Journal of Spinal Cord Medicine, 2021
Maria Pollifrone, Seema Sikka, Rita Hamilton
Takotsubo cardiomyopathy (TC), otherwise known as stress-induced cardiomyopathy, is a transient reduced left ventricular dysfunction with an unknown etiology. TC is Japanese in origin, and is named after a pot, the “takotsubo”, that is used to catch octopus. The shape of the pot is similar to the left ventricle shape in TC, with a broad bottom and smaller neck.1 A well accepted theory for the pathophysiology of TC is that a massive catecholamine release is responsible, although the exact process is unknown.1 This case report will discuss TC as a result of a severe episode of autonomic dysreflexia (AD) in a patient with chronic tetraplegia. Autonomic dysreflexia is a syndrome of imbalanced sympathetic discharge secondary to loss of descending central sympathetic control in persons with spinal cord injury (SCI) at thoracic level 6 or above due to noxious stimuli below the level of the injury.2 In this case, it is suspected that the stress induced release of catecholamines, due to impaired ability to decrease sympathetic output, was the cause for TC. The long-term effects of AD are relatively unknown, and this specific case raises the concern for the need to monitor cardiac function in spinal cord patients with frequent AD. This specific case illustrates the importance of education on recognition and management of AD in spinal cord patients.
Evidence-based care for individuals with spinal cord injury: Role of the Clinical Practice Guidelines
Published in The Journal of Spinal Cord Medicine, 2021
Carolann Murphy, Florian P. Thomas
The most recent Guideline is the third edition of a 1997 release on a topic that has accounted for more than 90% of PVA’s website traffic. The topic is autonomic dysreflexia, a sudden onset potentially life-threatening condition, presents major challenges to clinicians in emergency care who are unfamiliar with spinal cord injury. A panel co-chaired by Dr. Todd Linsenmeyer and Dr. Andrei Krassioukov adopted an expanded view of autonomic dysfunction after spinal cord injury in “Evaluating autonomic dysreflexia and other autonomic dysfunctions: Preventing the highs and lows.”3 Released in 2021, this Guideline recognizes a wider range of potential causes of autonomic dysreflexia, updates available treatments, and educates clinicians about the related conditions of orthostatic hypotension, hyperhidrosis, and thermodysregulation.