Objective To study the occurrence of autonomic hyper-all cases. Five patients showed a decrease in heart rate during the increase in blood pressure. However, in reflexia (AHR) after intradural sacral posterior rhizotomy combined with intradural sacral anterior root three patients the heart rate did not change or even sometimes slightly increased as the arterial blood stimulation, performed to manage the neurogenic hyper-reflexic bladder, and to determine the pathophy-pressure exceeded 160 mmHg, when the blood pressure and heart rate then increased together. siological basis of the uncontrolled hypertensive crisis after sacral de-aCerentation.Conclusions These results confirm that even after complete sacral de-aCerentation, AHR persisted in patients Patients and methods Ten patients with spinal cord injury operated using Brindley's method between with spinal cord injury and always occurred during the stimulation-induced voiding phase. In cases of September 1990 and February 1994 were reviewed. Systematic continuous non-invasive recordings of incomplete de-aCerentation, small uninhibited bladder contractions without voiding occurred during the fill-cardiovascular variables (using a photoplethysmograph) were made during urodynamic recordings and ing phase. The blood pressure then increased but never reached the value recorded during stimulation-the pre-and post-operative vesico-urethral and cardiovascular data compared.induced micturition. Stimulation of aCerents that enter the spinal cord by the thoracic and lumbar roots and Results Nine of the 10 patients were examined using a new prototype measurement system; one woman that are not influenced by sacral rhizotomy could explain why AHR increases during urine flow. The refused the last urodynamic assessment. Eight of the nine patients who presented with AHR before oper-distinct threshold of decreased heart rate by increasing blood pressure to >160 mmHg focuses attention on ation still had the condition afterward. There was a marked elevation in systolic and diastolic blood the chronotropic influences of the sympathetic nerves in the heart by an exhausted baroreceptor reflex. pressure during the urodynamic examination in all eight patients, despite complete intra-operative Keywords Autonomic hyper-reflexia, urodynamics, neurogenic bladder, spinal cord injury, sacral root de-aCerentation of the bladder in five. The elevation of blood pressure started during the stimulation-induced stimulation bladder contractions and increased during voiding in tract or from the rectum because of rectal impaction.
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