Symptomatic postprandial hypotension in high paraplegia. Case report

Abstract

Symptomatic postprandial decrease in blood pressure has been described in patients with various autonomic disorders, but not in patients with spinal injuries, Presented herein is a 31 year old female patient with traumatic complete paraplegia under the T3 level, in whom postprandial hypotension (PPH) was observed. The PPH was preceded by an increase in insulin level and was followed by an acceleration of heart rate. Oral caffeine prevented the hypotension and alleviated the symptoms. It is suggested that the PPH might be manifested as a result of damage to an upper thoracic spinal baroreflex. Clinical investigation of PPH is recommended for patients with high paraplegia.

Hemodynamic effects of liquid food ingestion in mid-thoracic paraplegia: is supine postprandial hypotension related to thoracic spinal cord damage?

“…In that case, the hypotension was symptomatic when food ingestion was followed by head-up tilting (HUT). 5 The demonstration of significant PPH in a patient with thoracic paraplegia but not in tetraplegia raised the hypothesis that the pathology causing PPH includes a thoracic but not a cervical SCL. To verify this hypothesis, we studied responses to food ingestion in a group of individuals with thoracic SCL and compared them with those of patients with cervical SCL and of healthy participants.…”

Autonomic Neuropathy and Cardiovascular Disease in Aging

“…The prevalence of OH among unselected elderly aged 70≤is between 6 to 30% (12)(13)(14). The occurrence of OH is higher in females than males and more common in blacks than whites (15,16).…”

“…(69,70). PPH has been associated with old age, autonomic dysfunction, falls, syncope, tabes dorsalis, Parkinson's disease, Alzheimer's disease, stroke, coronary artery disease, hypertension, diabetes mellitus, and increased frequency of all-cause mortality (1,15,(71)(72)(73)(74)(75)(76). Predisposing risk factors of PPH are polypharmacy, diuretics, hot meals (50 C <), rich carbohydrate diet, diabetes mellitus, autonomic dysfunction, Parkinson disease, end-stage renal (Figure 3).…”

Management of Postprandial Hypotension in a Tetraplegic Patient after Cervical Spinal Cord Injury

“…Postprandial hypotension (PPH) has been defined as a decrease in systolic blood pressure (BP) of 20 mmHg or a decrease <90 mmHg from a pressure of 100 mmHg within 2 h after a meal 6) . PPH occurs in elderly persons and in those with autonomic dysfunction, Parkinson disease, paraplegia, diabetes mellitus, tabes dorsalis, and ganglionic blockage 3,6) .…”