Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient

Vallès, Margarita; Benito, Juana Gómez; Portell, Enric; Vidal, Joan

doi:10.1038/sj.sc.3101780

Cited by 63 publications

(28 citation statements)

References 11 publications

(11 reference statements)

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“…3,4 During AD, systolic arterial blood pressure (BP) may increase to 300 mm Hg and may, without immediate treatment, result in seizure, intracranial hemorrhage, myocardial infarction or death. [5][6][7][8][9][10][11] A sudden and massive increase in systolic and diastolic BP (SBP and DBP, respectively) in response to noxious or non-noxious stimuli below the level of injury is a defining criterion for AD. 12 Bradycardia frequently accompanies episodes of AD and typically occurs as a result of baroreceptor-mediated increase in vagal activity above the neurological level owing to increased arterial BP; however, tachycardia is also documented in individuals suffering from AD.…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic urological triggers of autonomic dysreflexia: a systematic review

et al. 2015

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Study design: This is a systematic review. Objective: The objective of this study was to review the literature on iatrogenic urological triggers of autonomic dysreflexia (AD). Setting: This study was conducted in an international setting. Methods: A systematic review was conducted from PubMed search using AD/ autonomic hyperreflexia and spinal cord injury (SCI). Studies selected for review involved iatrogenic urological triggers of AD in individuals with SCI, including original articles, previous practice guidelines, case reports and literature reviews. Studies that did not report AD or blood pressure (BP) assessments during urological procedures were excluded. Results: Forty studies were included for analysis and categorized into four groups: (1) urodynamics and cystometry; (2) cystoscopy and transurethral litholapaxy; (3) extracorporeal shock-wave lithotripsy (ESWL); and (4) other procedures. During urodynamics, the incidence of AD ranged from 36.7% to 77.8%. The symptomatic rate ranged from 50% to 65%, with AD symptoms seen predominantly in cervical SCI patients. The studies imply no consensus regarding the relationship between AD, neurogenic detrusor overactivity and detrusor sphincter dyssynergia. Without anesthesia, the majority of individuals develop AD during cystoscopy, transurethral litholapaxy and ESWL. The effectiveness of different anesthesia methods relies on blocking the nociceptive signals from the lower urinary tract (LUT) below the level of the neurological lesion. Other iatrogenic urological triggers were commonly associated with bladder filling. Conclusion: The LUT triggers of episodes of AD are often associated with iatrogenic urological procedures. AD was more prevalent in cervical SCI than in thoracic SCI. To detect this potential life-threatening complication following cervical and high thoracic SCI, routine BP monitoring during urological procedures is highly recommended.

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Section: Introductionmentioning

confidence: 99%

Iatrogenic urological triggers of autonomic dysreflexia: a systematic review

et al. 2015

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“…[1][2][3][4] AD is accompanied by sweating, flushing, and a pounding headache 1,4 and can lead to severe morbidity and even mortality. [5][6][7][8] Clinically, AD has been well documented, but the mechanisms that mediate AD remain unclear. 9 Because AD is induced by exaggerated sympathetic activity, it is thought to be ␣-adrenergic mediated.…”

mentioning

confidence: 99%

Sympathetic Nonadrenergic Transmission Contributes to Autonomic Dysreflexia in Spinal Cord–Injured Individuals

Groothuis

Rongen²,

Deinum³

et al. 2010

Hypertension

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Abstract-Autonomic dysreflexia is a hypertensive episode in spinal cord-injured individuals induced by exaggerated sympathetic activity and thought to be ␣-adrenergic mediated. ␣-Adrenoceptor antagonists have been a rational first choice; nevertheless, calcium channel blockers are primarily used in autonomic dysreflexia management. However, ␣-adrenoceptor blockade may leave a residual vasoconstrictor response to sympathetic nonadrenergic transmission unaffected. The aim was to assess the ␣-adrenergic contribution and, in addition, the role of supraspinal control to leg vasoconstriction during exaggerated sympathetic activity provoked by autonomic dysreflexia in spinal cord-injured individuals and by a cold pressure test in control individuals. Upper leg blood flow was measured using venous occlusion plethysmography during supine rest and during exaggerated sympathetic activity in 6 spinal cord-injured individuals and 7 able-bodied control individuals, without and with phentolamine (␣-adrenoceptor antagonist) and nicardipine (calcium channel blocker) infusion into the right femoral artery.

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“…22) In fact, a life-threatening episode of AD occurred 2 weeks after the initial minor episode in the present patient. We definitely need to recognize the risk of AD recurrence.…”

Section: T Yamashita Et Almentioning

confidence: 96%

“…10,17) Furthermore, iatrogenic triggering factors, such as cystoscopy, cystometry, or electrical stimulation of muscles, are also known. 15) Intracranial hemorrhage is a rare complication of AD 6,9,19,[22][23][24] with only a few cases of fatal massive hemorrhage secondary to AD. 6,9,24) We treated a patient with quadriparesis after SCI who developed multiple intracranial hemorrhages, which seemed to be related to posterior reversible encephalopathy syndrome (PRES) secondary to AD.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Hemorrhage Due to Posterior Reversible Encephalopathy Syndrome Associated With Autonomic Dysreflexia in a Spinal Cord Injury Patient

Yamashita

Hiramatsu

Sakai

et al. 2012

Neurol. Med. Chir.(Tokyo)

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A 37-year-old man with C4-5 spinal cord injury (SCI) presented with abnormally high blood pressure after vesicocutaneous catheter exchange and was treated with antihypertensive agents. Two weeks later, he developed headache and visual disturbance, and presented with fluctuating blood pressure. Multiple subcortical hemorrhages in the left occipital and right frontal lobes occurred on the next day, and he died of increased intracranial pressure 3 weeks later. Based on the symptoms and computed tomography findings, the retrospective diagnosis was posterior reversible encephalopathy syndrome (PRES) due to autonomic dysreflexia (AD). AD occurs frequently in patients with quadriplegia and high paraplegia by distention of the bladder and bowel. PRES secondary to AD is very rare, but we must always be aware of this life-threatening complication in SCI patients.

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Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient

Cited by 63 publications

References 11 publications

Iatrogenic urological triggers of autonomic dysreflexia: a systematic review

Iatrogenic urological triggers of autonomic dysreflexia: a systematic review

Sympathetic Nonadrenergic Transmission Contributes to Autonomic Dysreflexia in Spinal Cord–Injured Individuals

Cerebral Hemorrhage Due to Posterior Reversible Encephalopathy Syndrome Associated With Autonomic Dysreflexia in a Spinal Cord Injury Patient

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