Management of autonomic dysreflexia

Breault, Guy; Altaweel, Waleed; Corcos, Jacques

doi:10.1007/s11884-008-0003-x

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…180 These immediate interventions should occur while the patient is in a seated in an upright posture, or with the head elevated, in order to initiate orthostatically-mediated declines in blood pressure and oppose the pressor effect of AD. Once an AD event is triggered, and is unresponsive to attempts to remove the triggering stimulus (blood pressure continues to be elevated above 150 mmHg), it may be required to intervene pharmacologically.…”

Section: Clinical Management Of Abnormal Cardiovascular Control Follomentioning

confidence: 99%

“…Recently, prazosin (1 mg oral tablet) effectively reduced AD severity (due to penile vibrostimulation) while exerting no effect on resting blood pressure, suggesting it may be a viable option for treating AD 182 . For detailed guidelines on management of AD see: 47,180 It is also possible that botulinum toxin A (Botox) can reduce the frequency and severity of AD secondary to detrusor muscle overactivity. 183,184 Typically, 200 units of Botox is injected per procedure (diluted in 15mL saline to 20U/mL), where it is injected into the detrusor muscle at 20 sites (10U per site), sparing the trigone (see clinical vignette).…”

Section: Clinical Management Of Abnormal Cardiovascular Control Follomentioning

confidence: 99%

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Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management

Phillips

Krassioukov

2015

Journal of Neurotrauma

158

136

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Cardiovascular (CV) issues after spinal cord injury (SCI) are of paramount importance considering they are the leading cause of death in this population. Disruption of autonomic pathways leads to a highly unstable CV system, with impaired blood pressure (BP) and heart rate regulation. In addition to low resting BP, on a daily basis the majority of those with SCI suffer from transient episodes of aberrantly low and high BP (termed orthostatic hypotension and autonomic dysreflexia, respectively). In fact, autonomic issues, including resolution of autonomic dysreflexia, are frequently ranked by individuals with high-level SCI to be of greater priority than walking again. Owing to a combination of these autonomic disturbances and a myriad of lifestyle factors, the pernicious process of CV disease is accelerated post-SCI. Unfortunately, these secondary consequences of SCI are only beginning to receive appropriate clinical attention. Immediately after high-level SCI, major CV abnormalities present in the form of neurogenic shock. After subsiding, new issues related to BP instability arise, including orthostatic hypotension and autonomic dysreflexia. This review describes autonomic control over the CV system before injury and the mechanisms underlying CV abnormalities post-SCI, while also detailing the end-organ consequences, including those of the heart, as well as the systemic and cerebral vasculature. The tertiary impact of CV dysfunction will also be discussed, such as the potential impediment of rehabilitation, and impaired cognitive function. In the recent past, our understanding of autonomic dysfunctions post-SCI has been greatly enhanced; however, it is vital to further develop our understanding of the long-term consequences of these conditions, which will equip us to better manage CV disease morbidity and mortality in this population.

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Section: Clinical Management Of Abnormal Cardiovascular Control Follomentioning

confidence: 99%

Section: Clinical Management Of Abnormal Cardiovascular Control Follomentioning

confidence: 99%

Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management

Phillips

Krassioukov

2015

Journal of Neurotrauma

158

136

View full text Add to dashboard Cite

show abstract

“…Our data showed no significant association between injury level and sleep quality which is in line with Verheggen et al [22] assessing sleep quality in SCI patients with PSQI. Although some sleep disturbing factors such as autonomic dysreflexia is known to be more frequent in higher spinal cord lesions [30][31][32], totally it seems that sleep initiation and duration and patients satisfaction of sleep quality does not differ in SCI patients with different injury levels.…”

Section: Discussionmentioning

confidence: 99%

Subjective Sleep Quality in Iranian Patients with Spinal Cord Injury: Results of Pittsburgh Sleep Quality Index in a Referral Center

2014

J Neurol Psychol

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Background: Sleep quality is an important factor influencing quality of life in patients with spinal cord injury (SCI). Our purpose was to evaluate and report sleep quality in Iranian individuals with SCI in a referral center. Methods:We assessed sleep quality by using Pittsburgh Sleep Quality Index (PSQI) which is the self-expressing standard questionnaire to evaluate subjective sleep quality. All patients with SCI who were referred to Brain and Spinal Injury Research Center (BASIR) and did not meet exclusion criteria entered the study.Results: Total of 100 patients entered the study. Thirty eight patients (38%) of SCI patients had PSQI total score higher than 5. The association between spinal cord independence score (SCIM) and sleep quality was significant in female patients in components of subjective sleep quality, necessity of using sleeping medications and daytime dysfunction (P: 0.02, 0.01 and 0.003, respectively). Both genders had significantly less sleep disturbance and latency at higher SCIM scores. Level of injury was not associated with sleep quality. Data was collected within 4 months from January 2013 till April 2013. Conclusion:While decreased sleep quality is reported in spinal cord injured (SCI) patients, our data showed the similar frequency of reduced sleep quality in Iranian SCI patients in comparison with general population in Tehran. Females sleep quality pattern relationship with SCIM was different from male participants while they showed similarity especially in sleep latency, duration and disturbance components. Although sleep quality in SCI population in Iran does not seem to be higher than general population, the rate is still high and requires attention.

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Cardiovascular Dysfunction Following Spinal Cord Injury

Phillips

Krassioukov

2017

Neurological Aspects of Spinal Cord Injury

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Management of autonomic dysreflexia

Cited by 4 publications

References 28 publications

Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management

Contemporary Cardiovascular Concerns after Spinal Cord Injury: Mechanisms, Maladaptations, and Management

Subjective Sleep Quality in Iranian Patients with Spinal Cord Injury: Results of Pittsburgh Sleep Quality Index in a Referral Center

Cardiovascular Dysfunction Following Spinal Cord Injury

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