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Autonomic dysreflexia presenting as a severe headache.
W A McClain1, C P Shields, D M Sixsmith
1Department of Emergency Medicine, New York Hospital Medical Center of Queens, Flushing, NY 11355-5095, USA.
The American Journal of Emergency Medicine
|May 25, 1999
Summary
Autonomic dysreflexia, a condition affecting individuals with spinal cord injuries above T6, can be triggered by stimuli below the injury level. This case study highlights a urinary tract infection as a cause of autonomic dysreflexia 8 years post-injury.
Area of Science:
- Neurology
- Urology
- Rehabilitation Medicine
Background:
- Autonomic dysreflexia (AD) is a potentially life-threatening condition typically affecting individuals with spinal cord injuries (SCI) at or above the T6 level.
- It arises from altered autonomic nervous system function following plastic changes in afferent pathways, leading to an exaggerated sympathetic response to noxious stimuli below the level of the lesion.
Observation:
- This report details a case of a male paraplegic patient who experienced autonomic dysreflexia eight years after his initial spinal cord injury.
- The patient's symptoms, including hypertension, bradycardia, and severe headache, were triggered by a urinary tract infection (UTI).
Findings:
- The study underscores that autonomic dysreflexia can manifest years after the initial injury, with the onset documented between 30 days and 13 years post-injury.
- Urinary tract infections are identified as a significant and potentially delayed trigger for autonomic dysreflexia in individuals with SCI.
Implications:
- This case highlights the importance of recognizing urinary tract infections as a critical precipitating factor for autonomic dysreflexia, even many years after spinal cord injury.
- Healthcare providers should maintain a high index of suspicion for UTIs in SCI patients presenting with symptoms of autonomic dysreflexia, regardless of the time elapsed since injury.
- Early diagnosis and management of UTIs are crucial for preventing severe complications associated with autonomic dysreflexia.