Intracerebral hemorrhage secondary to autonomic dysreflexia in a young person with incomplete C8 tetraplegia: A case report

Pan, Shin-Liang; Wang, Yen-Ho; Lin, Hui-Lin; Chang, Chen‐Yi; Wu, Ti-Yi; Hsieh, Eou-Ting

doi:10.1016/j.apmr.2004.03.021

Cited by 49 publications

(30 citation statements)

References 9 publications

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“…7 Furthermore, following the rise in blood pressure, reflex bradycardia commonly occurs, although tachycardia has been reported. [8][9][10] Delayed diagnosis and inadequate management of AD may result in stroke, 11 myocardial infarction, 12 and even death. 13 Thus, the early recognition and prompt management of this life-threatening, but easily treatable, condition among emergency room (ER) staff and SCI health care professionals (HCPs) is vital.…”

Section: Introductionmentioning

confidence: 99%

“The ABCs of AD”: A prospective evaluation of the efficacy of an educational intervention to increase knowledge of autonomic dysreflexia management among emergency health care professionals

Krassioukov

Tomasone

Pak

et al. 2015

The Journal of Spinal Cord Medicine

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Context/Objective: Despite the availability of consensus-based resources, first responders and emergency room (ER) health care professionals (HCPs) have limited knowledge regarding autonomic dysreflexia (AD) recognition and treatment. The purpose of this study was to assess the efficacy of "The ABCs of AD" educational seminar for improving HCPs' short-and long-term knowledge of AD recognition, diagnosis, and management. Design: Multi-center prospective pre, post, and follow-up questionnaire study. Setting: Level I trauma centers with emergency departments in British Columbia, Manitoba, and Ontario. Methods: ER professionals completed measures immediately before and after (n = 108), as well as 3-months following (n = 23), attendance at "The ABCs of AD" seminar. Outcome Measures: AD knowledge test; seminar feedback. Results: Following the seminar, participants had higher ratings of their AD knowledge and had significantly higher AD knowledge test scores (M ± SD pre = 11.85 ± 3.88, M ± SD post = 18.95 ± 2.39, out of 22; P < 0.001, d = 2.21). Most participants believed the seminar changed their AD knowledge, and rated the seminar information as having the potential to influence and change their practice. AD knowledge test scores significantly decreased between post-seminar and 3-month follow-up (M ± SD 3mo = 17.04 ± 3.28; P = 0.004, d = -0.70); however, 3-month scores remained significantly higher than baseline. Conclusion: "The ABCs of AD" seminar improves HCPs' perceived and actual AD knowledge in the short-term. To enhance knowledge retention in both the short-and long-term, the inclusion of additional active learning strategies and follow-up activities are recommended. The seminar is being translated into an online training module to enhance the dissemination of the AD clinical practice guidelines among first responders, ER staff, and SCI practitioners.

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Section: Introductionmentioning

confidence: 99%

“The ABCs of AD”: A prospective evaluation of the efficacy of an educational intervention to increase knowledge of autonomic dysreflexia management among emergency health care professionals

Krassioukov

Tomasone

Pak

et al. 2015

The Journal of Spinal Cord Medicine

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“…12,13 AD occurs when there is damage to the spinal cord tissue, which induces a myriad of systemic changes, including a loss of descending sympathetic inhibition, 14 changes in spinal sympathetic circuitry, 15,16 and hypersensitization of the peripheral adrenergic receptors (ARs). 17,18 AD has been directly implicated in acute clinical cardiovascular events post-SCI, such as cerebral hemorrhage, 19,20 myocardial infarction, 21 and even death. 22 There are also likely to be long-term deleterious consequences of AD on the cardiovascular system.…”

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confidence: 99%

Cardiac Consequences of Autonomic Dysreflexia in Spinal Cord Injury

et al. 2016

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Abstract-Autonomic dysreflexia (AD), which describes episodic hypertension, is highly prevalent in people with spinal cord injury (SCI). In non-SCI, primary hypertension depresses cardiac contractile reserve via β-adrenergic mechanisms.In this study, we investigated whether AD contributes to the impairment in cardiac contractile function that accompanies SCI. We induced SCI in rodents and stratified them into sham, SCI, or SCI plus repetitive induction of AD. At 6-week post-SCI, we assessed cardiac function using in vivo (speckle-tracking echocardiography), ex vivo (working heart), and molecular approaches (Western blot). We also provide unique translational insight by comparing the relationship between the number of daily AD events and cardiac function in 14 individuals with cervical SCI. We found SCI and SCI plus repetitive induction of AD exhibited a reduction in left ventricular dimensions at 6-week post-SCI versus preinjury (P<0.049). Compared with sham, SCI exhibited a reduction in peak radial strain along with a down and rightward shift in the Starling curve (P<0.037), both of which were further depressed in SCI plus repetitive induction of AD (P<0.042). In response to β-adrenergic stimulation, SCI plus repetitive induction of AD exhibited an attenuated increase in contractile indices (P<0.001), despite no differences in β-receptor expression within the left ventricle. Our clinical data confirm our experimental findings by demonstrating significant associations between the number of daily AD events and markers of systolic and diastolic function along with left ventricular mechanics. Here, we provide the first evidence from a translational perspective that AD exerts insidious effects on cardiac function in rodents and humans with SCI.

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“…2,3 Delayed recognition and unmanaged episodes of AD can lead to myocardial infarction, 4 intracranial hemorrhage, 5 and even death. 6 However, such outcomes are avoidable if AD is recognized and managed promptly.…”

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confidence: 99%

The “ABCs of AD”: A pilot test of an online educational module to increase use of the autonomic dysreflexia clinical practice guidelines among paramedic and nurse trainees

Tomasone¹,

Ginis²,

Pulkkinen³

et al. 2014

The Journal of Spinal Cord Medicine

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Context/Objective: Despite availability of clinical practice guidelines (CPGs), gaps in autonomic dysreflexia (AD) knowledge and practice persist. A free, online educational module, the "ABCs of AD", was developed to improve knowledge of the AD-CPGs among emergency healthcare personnel. We examine short-term changes in paramedic and nurse trainees' knowledge of, and social cognitions towards using, the AD-CPGs following module completion. Design: Pre-post. Methods: Thirty-four paramedic and nurse trainees from two training programs in Canada completed measures immediately before and after viewing the online "ABCs of AD" module. Outcome measures: AD knowledge test; Theory of Planned Behavior social cognition questionnaire; module feedback survey. Results: Paired samples t-tests revealed significant increases in participants' AD knowledge test scores (M ± SDpre = 9.00 ± 2.46, M ± SDpost = 12.03 ± 4.07, P < 0.001; d = 0.84). Prior to viewing the module, participants reported positive social cognitions for using the AD-CPGs (all Ms ≥ 4.84 out of 7). From pre-to post-module, no significant changes were seen in participants' social cognitions for using the AD-CPGs. Participants' average module viewing time was 36.73 ± 24.17 minutes (range 8-90 minutes). There was a decline in viewing from the first to the last module sections, with only half of participants viewing all six sections. Conclusion: Knowledge alone is insufficient for clinical behavior change; as such, social cognitive determinants of behavior should be explicitly targeted in future iterations of the module to increase the likelihood of increased use of the AD-CPGs. To engage viewers across all module sections, the "ABCs of AD" module should include supplementary learning strategies, such as interactive quizzes and peer-to-peer interaction.

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Intracerebral hemorrhage secondary to autonomic dysreflexia in a young person with incomplete C8 tetraplegia: A case report

Cited by 49 publications

References 9 publications

“The ABCs of AD”: A prospective evaluation of the efficacy of an educational intervention to increase knowledge of autonomic dysreflexia management among emergency health care professionals

“The ABCs of AD”: A prospective evaluation of the efficacy of an educational intervention to increase knowledge of autonomic dysreflexia management among emergency health care professionals

Cardiac Consequences of Autonomic Dysreflexia in Spinal Cord Injury

The “ABCs of AD”: A pilot test of an online educational module to increase use of the autonomic dysreflexia clinical practice guidelines among paramedic and nurse trainees

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