Early autonomic dysreflexia

Abstract

Introduction: During the stage of spinal shock the conventional view is that autonomic activity is abolished. Here, evidence is presented that autonomic activity is still present. Patients: Four patients with acute cord transactions are presented: one new case and three from the literature. De®nitions: The de®nitions of spinal shock and autonomic dysre¯exia are given. Methods: All four cases showed acute autonomic dysre¯exia between 7 and 31 days after acute cord transection at a stage when the tendon re¯exes were abolished. Results: Two cases showed a severe rise in blood pressure; the two earlier cases, before blood pressure was routinely recorded, profuse sweating. In two cases autonomic dysre¯exia was obtained when the bladder was overdistended with 1000 ml and 1600 ml. In the other two cases it occurred in response to traumatic catheterisation. This was found when supramaximal stimuli were applied. It has not been recorded routinely as, with modern management, the bladder does not get overdistended or traumatised. Discussion: Other evidence, the blood pressure, and urethral tone is presented to show that sympathetic re¯ex activity of the cord is not abolished during spinal shock. Clinical signi®cance: The clinical importance of this is that autonomic dysre¯exia can be seen at an early stage and it should be considered in the di erential diagnosis of a sick patient immediately after spinal injury. Spinal Cord (2000) 38, 229 ± 233

Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury

“…This cut-off time was selected because the majority of patients who were discharged from the hospital at acute stage used indwelling urethral catheters; instead, we wanted to explore the relationship between bowel and bladder management methods, and AD at chronic stage. AD can occur at any time after injury even within the first few days 16,17 and commonly develops in patients with tetraplegia or high-level paraplegia at 3-4 months after the cord lesion; 18 (3) no pressure ulcerations, deep venous thrombosis, ureteral or renal stones or heterotopic ossification throughout hospitalization to exclude possible influence of these complications on cardiovascular condition.…”

Spinal shock revisited: a four-phase model

“…This is usually due to a distended viscus (eg, bladder or bowel) acting as a stimulus causing massive sympathetic outflow below the zone of injury, which is unregulated by supraspinal input. One case report 79 suggested that autonomic dysreflexia may occur as early as 7 days after a complete injury, but the general time course of its development requires further study.…”

Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology

“…8 Previously, it was felt that the hypotensive episodes were confined to the acute period following SCI, and autonomic dysreflexia to the chronic phase of SCI. 6 However, it has also been shown that autonomic dysreflexia can present in the early phases of SCI, 23,24 and that orthostatic hypotension can persist for years, and often becomes worse with time. 25 Numerous investigators identified various possible mechanisms that are likely to be responsible for the abnormal sympathetic cardiovascular control following SCI (Table 1).…”