Autonomic dysreflexia in a tetraplegic patient due to a blocked urethral catheter: spinal cord injury patients with lesions above T-6 require prompt treatment of an obstructed urinary catheter to prevent life-threatening complications of autonomic dysreflexia

Abstract

BackgroundThe Manchester Triage System is commonly used as the triage system in emergency departments of the UK. As per the Manchester Triage System, patients presenting with retention of urine to the accident and emergency department are categorized to yellow, which denotes that the ideal maximum time to first contact with a treating clinician will be 60 min. Cervical spinal cord injury patients, in whom urinary catheter is blocked, may develop suddenly headache, sweating, high blood pressure, cardiac dysrhythmia, convulsions, intracranial bleed, and acute neurogenic pulmonary oedema as a result of autonomic dysreflexia due to a distended bladder.Case presentationA 46-year-old male with C-6 tetraplegia developed urinary retention because of a blocked catheter. He was seen immediately on arrival in the spinal injuries unit. The blocked catheter was removed and a new catheter was about to be inserted. Then this patient said that the ceiling lights were very bright and glaring. Five milligrams of Nifedipine was given sublingually. This patient started having fits involving his head, face, neck and shoulders with loss of consciousness. A 14-French silicone Foley catheter was inserted per urethra without any delay and 300 ml of clear urine was drained. This patient recovered consciousness within 5 min. Computed tomography of the brain revealed no focal cerebral or cerebellar abnormality. There was no intra-cranial haemorrhage.ConclusionThis case illustrates that spinal cord injury patients with lesion above T-6, who develop retention of urine because of a blocked catheter, may look apparently well, but these patients can develop suddenly life-threatening autonomic dysreflexia. Therefore, spinal cord injury patients, who present to the accident and emergency department or spinal units with a blocked urinary catheter, should be seen urgently although their vital signs may be stable on arrival. Increasing the awareness of staff in emergency departments regarding autonomic dysreflexia as well as education of the patient and carers will be useful in preventing this complication in persons with spinal cord injury.

Acute Severe Autonomic Dysreflexia during Spinal Cord Intramedullary Tumor Resectione

“…Surgeon and anesthesiologist must remain vigilant, as the case may be quite severe and without warning. According to reports, episodic hypertension could develop in 50-90% of people who suffered tetraplegia or high thoracic cord lesions (5). This reflex could be seen in patients with complete or incomplete injury to the T6 or higher levels of cord (6), although autonomic dysreflexia has been reported with injuries to T8 level of spinal cord.…”

Missed signs of autonomic dysreflexia in a tetraplegic patient after incorrect placement of urethral Foley catheter: a case report

“…Had ultrasound scan or CT been done promptly, the medical mishap of incorrect placement of Foley catheter would have been detected without delay. Autonomic dysreflexia can become a life-threatening event in tetraplegic subjects; emergency room physicians should be aware of the varied clinical features of autonomic dysreflexia, and take prompt action in order to avert serious complications such as convulsions [7], brain haemorrhage [8], and death [9].…”

Severe autonomic dysreflexia induced cardiac arrest under isoflurane anesthesia in a patient with lower thoracic spine injury

“…[4] The onset of AD in a tetraplegic patient following the removal of blocked urinary catheter and while the external urethral meatus was being cleaned with chlorhexidine prior to catheterization has been described. [11] Afferent impulses are transmitted through pelvic, pudendal and hypogastric nerves to the isolated spinal cord and cause massive sympathetic response from adrenal medulla and sympathetic nervous system which is no longer under central hypothalamic control. Vasoconstriction occurs below the level of the lesion causing hypertension.…”