Fatal cerebral hemorrhage due to autonomic dysreflexia in a tetraplegic patient: case report and review

Eltorai, Ibrahim M.; Kim, R; Vulpe, Michael; Kasravi, H; Ho, Wen-Tsao

doi:10.1038/sc.1992.82

Cited by 122 publications

(86 citation statements)

References 7 publications

(5 reference statements)

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“…The subjects were closely monitored on symptoms of AD before and during the execution of the test. Symptoms of AD 18,25 are extreme hypertension, abnormal high or low HR. Above lesion level: pounding headache, initially pallor, flushed skin, excessive sweating, nasal stuffiness and anxiety.…”

Section: Subjectsmentioning

confidence: 99%

“…AD should be prevented because in some cases extremely high BP-values can even lead to death from cardiac dysfunction or a stroke. 18 Physical capacity Two subjects (15 and 16) had to be excluded from further analysis because they were not able to complete more than three blocks, despite very small increments per bout (2 W). A very low physical capacity is often seen in these subjects, especially in (untrained) persons with a C5-C6 lesion.…”

Section: Strength Of the Hr-vo 2 Relationshipmentioning

confidence: 99%

“…Furthermore, as a consequence of the disturbed sympathetic innervation, autonomic dysreflexia (AD) may occur in subjects with a lesion level at or above Th6. 18 AD may result in an uncontrolled elevation of BP, and during exercise, this may lead to sudden changes in HR and eventually a higher HR peak and VO 2peak . 19 Apart from the disturbed sympathetic innervation, persons with TP have a low physical capacity as a consequence of the low active muscle mass and inactivity of the venous muscle pump.…”

Section: Introductionmentioning

confidence: 99%

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The individual relationship between heart rate and oxygen uptake in people with a tetraplegia during exercise

et al. 2006

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Study design: Descriptive study. Objective: To examine the individual heart rate-oxygen uptake (HR-VO 2 ) relationship during exercise in persons with tetraplegia (TP). Setting: Rehabilitation Centre Heliomare, Wijk aan Zee, The Netherlands. Methods: The HR-VO 2 relationship was determined in untrained subjects with motor complete TP (C5 or C6, n ¼ 10 and C7 or C8, n ¼ 10) during a discontinuous graded exercise hand cycle test. The mean HR and VO 2 of the final 60 s of 2-min exercise blocks were used for calculation of the individual correlation coefficient and the standard error of the estimate (SEE). Results: Two subjects of the C5-C6 group were not able to complete the test. Individual Pearson's correlation coefficients (r) ranged from 0.68 to 0.97 and SEE from 2.6 to 22.4% VO 2 -Reserve (VO 2 R). The mean Pearson's r and SEE were 0.8170.12 and 10.675.6% VO 2 R in the C5-C6 group and 0.9170.07 and 7.073.2% VO 2 R in the C7-C8 group, respectively. Two subjects of the C5-C6 group and six subjects of the C7-C8 group attained a linear HR-VO 2 relationship with an acceptable SEE (p6.0%) and r (40.90). Conclusions: The HR-VO 2 relationship appeared linear in only eight out of 18 subjects. An individual analysis of the HR-VO 2 relationship is necessary to determine whether HR can be used to quantify exercise intensity. The use of HR to prescribe training intensity should be reconsidered in persons with TP. Sponsorship: This study is supported from a grant by ZON-MW.

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Section: Subjectsmentioning

confidence: 99%

Section: Strength Of the Hr-vo 2 Relationshipmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The individual relationship between heart rate and oxygen uptake in people with a tetraplegia during exercise

et al. 2006

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“…1 Less common complications have included myocardial infarction, seizures, intracerebral bleeds and visual de®cits. 2 It is believed that stimulation of pelvic or presacral nerves is one of the trigger mechanisms for this syndrome in patients with suprasacral spinal cord injury. A variety of stimuli induce dysre¯exic symptoms, though the commonest is probably bladder distension.…”

Section: Introductionmentioning

confidence: 99%

Neuropathic lumbar spondylolisthesis – a rare trigger for posture induced autonomic dysreflexia

Thumbikat

Ravichandran

2001

Spinal Cord

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Study design: Case report. Objectives: Description of a rare trigger for autonomic dysre¯exia. Setting: Princess Royal Spinal Injuries Unit, She eld. 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 dysre¯exia, 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 identi®ed 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 dysre¯exia 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. Spinal Cord (2001) 39, 564 ± 567

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“…They also found 10 cases in the literature related to this pathology. We have found five references of cerebral hemorrhage, [11][12][13][14] with two of them resulting in death. 12,14 …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2005

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Study design: Case report. Objective: To report an uncommon case of cerebral hemorrhage due to autonomic dysreflexia (AD) in a spinal cord injury (SCI) patient. Setting: Institut Guttmann, Neurorehabilitation Hospital in Barcelona, Spain. Case report: An SCI patient developed AD due to urinary tract infection after surgery for a pressure sore. The hypertension was difficult to control and the case progressed to hypertensive encephalopathy. MRI of the brain was performed showing a hemorrhagic lesion on the left occipital area. The hypertension was finally controlled and the neurological status improved although with some cognitive deficits. Conclusion: This is an uncommon case of cerebral hemorrhage due to AD, showing the importance of an adequate diagnosis and treatment of AD to avoid this life-threatening complication.Spinal Cord (2005) 43, 738-740.

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Fatal cerebral hemorrhage due to autonomic dysreflexia in a tetraplegic patient: case report and review

Cited by 122 publications

References 7 publications

The individual relationship between heart rate and oxygen uptake in people with a tetraplegia during exercise

The individual relationship between heart rate and oxygen uptake in people with a tetraplegia during exercise

Neuropathic lumbar spondylolisthesis – a rare trigger for posture induced autonomic dysreflexia

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

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