Tag: blood pressure
University of Louisville researchers are finding ways to help those who suffer catastrophic spinal cord injuries battle other health problems related to their injury.
Patients with spinal cord injury or neurological conditions may have neurogenic bowel dysfunction, which often means they depend on routine interventional bowel care, including the digital (manual) removal of faeces (DRF).
Some of these patients, especially those with spinal cord injury above T6, are particularly susceptible to the potentially life-threatening condition autonomic dysreflexia, which is characterised by a rapid rise in blood pressure, risking cerebral haemorrhage and death. A small number of patients who have had a severe stroke or who have severe forms of Parkinson’s Disease, multiple sclerosis, cerebral palsy, or spina bifida may also be susceptible to autonomic dysreflexia.
Patients with severe spinal cord injury (SCI) often experience chronically low blood pressure that negatively affects their health, their quality of life, and their ability to engage in rehabilitative therapy.
“People with severe spinal cord injury – especially when it occurs in a higher level in the spine – have problems with blood pressure regulation to the point that it becomes the main factor affecting quality of life for them,” said Glenn Hirsch, M.D., professor of cardiology at the University of Louisville (UofL). “Some cannot even sit up without passing out. They are forced to use medications, compression stockings, or abdominal binders to maintain an adequate blood pressure.”
The body is a series of checks and balances. This is true of muscles that push and countering muscles that pull. It is also true of the nervous system that operates in a balancing type of process. Individuals with higher level spinal cord injury can develop a complication called Autonomic Dysreflexia (AD). This is a condition where the sympathetic nervous system is left unchecked by the parasympathetic nervous system.
There is a bundle of nerves at the Thoracic vertebrae number six (T6) level that is a major junction where nerves come close together in the spinal cord. Individuals with spinal cord injury above this level have a disruption in the nerve segment. For these individuals, stimulation of the body at or below T6 can send confusing messages to the brain as the message will create a huge discharge of the sympathetic nervous system using all of the blood flow in the abdomen without the counter control of the parasympathetic nervous system to contain it. Blood pressure rises to extremely high proportions.
Autonomic Dysreflexia is a life threatening condition that can cause death.
The most common causes of Autonomic Dysreflexia are bladder and bowel distension.
Signs and Symptoms: Raised BP, bradycardia, pounding headache, flushing, sweating or blotching above level of injury; pale, cold, goosebumps below level of injury.
Autonomic hyperreflexia after spinal cord injury managed successfully with intravenous lidocaine: a case report
Some paraplegic patients may wish undergo some surgical procedures, like urological procedures, without anesthesia. However, these patients can develop autonomic hyperreflexia if cystoscopy is performed without anesthesia.
We present a case of severe autonomic hyperreflexia in a 44-year-old male with spinal cord injury at the level of T4 during urologic procedure under sedation and analgesia successfully treated with intravenous lidocaine.