No abstract

During initial and follow up observation were 190 patients with C4-D1 tetraplegia for 7 years, changes in the clinical and functional status were traced, which showed the greatest dynamics in patients with motor levels C6, C7. Patients with cervical tetraplegia, according to the criterion of functional and motor homogeneity, can be divided into 4 clinical and rehabilitation groups: 1) patients with a high level of damage to C4-C6 (functionally dependent); 2) patients with a low level of damage to C7-D1 (functionally independent); 3) patients with complete motor damage (types A and B); 4) patients with incomplete motor damage (types C and D).

Autonomic dysreflexia (AD) is a potentially life-threatening condition that develops in patients with spinal cord injury (SCI) at or above the T6 segment. First of all this condition is characterized by uncontrolled arterial hypertension, which can lead to catastrophic complications and even death. The trigger for the development of AD is often urological complications, as well as diagnostic and therapeutic manipulations on the lower urinary tract. It is important for urologists to be aware of the AD syndrome, clinical features of AD, acute and chronic management, as well as prevention episodes of AD in patients with neurogenic lower urinary dysfunction. AD is defined as an increase of systolic blood pressure of 20 mmHg from baseline in response to various afferent stimuli originating below the level of spinal cord injury. AD is based on exaltation of spinal reflex activity with irradiation of impulses in the spinal cord under conditions of dennervation preganglionic sympathetic neurons located above the T6 segment and hyperactivity of peripheral -adrenergic receptors. The main pathophysiological mechanism of AD is hypernoradrenalinemia, leading to vasoconstriction the vessels of the skin, abdominal cavity, muscles below the level of neurological injury.