Anxiety masquerading as autonomic dysreflexia
Ryan Solinsky1,2, Todd A Linsenmeyer3,4,5
1Spaulding Rehabilitation Hospital , Boston , Massachusetts , USA.
The Journal of Spinal Cord Medicine
|September 11, 2018
Summary
Anxiety can cause hypertension in spinal cord injury (SCI) patients, mimicking autonomic dysreflexia (AD). Consider psychological state alongside AD management for accurate diagnosis and treatment in SCI individuals.
Area of Science:
- Neuroscience
- Cardiovascular Medicine
- Rehabilitation Medicine
Background:
- Autonomic dysreflexia (AD) is a potentially life-threatening condition characterized by sudden hypertension in individuals with spinal cord injuries (SCI) at T6 or above.
- Prompt recognition and management of AD are crucial to prevent severe complications.
- Distinguishing AD from other causes of hypertension in SCI patients can be challenging.
Observation:
- Two cases of SCI patients presenting with acute hypertension during urodynamic testing are described.
- Case 1: A 77-year-old male with C4 AIS D SCI experienced a rapid rise in systolic blood pressure (SBP) from 138 to 170 mmHg, which resolved upon postponement of the procedure.
- Case 2: A 57-year-old male with T12 AIS A SCI showed elevated SBP from 140 to 170 mmHg during bladder filling, decreasing shortly after the procedure was stopped.
Findings:
- Both individuals had a history of anxiety, suggesting psychological distress as the cause of hypertension.
- The hypertension in both cases resolved quickly once the anxiety-provoking stimulus (urodynamics) was removed or postponed.
- These cases highlight that anxiety-induced hypertension can mimic AD in SCI patients.
Implications:
- Psychological factors, particularly anxiety, should be considered in the differential diagnosis of hypertension in SCI patients.
- Incorporating psychological assessment and management strategies alongside traditional AD protocols may improve diagnostic accuracy.
- The findings may offer an explanation for reported cases of AD in individuals with SCI below T6.
Related Concept Videos
01:18Anxiety: Overview
1.1K
Anxiety is a common mental disorder featuring excessive worry, fear, and apprehension, significantly affecting daily life. People with anxiety disorders experience persistent and intense anxiety, interrupting their everyday functioning.
Individuals with anxiety often experience a range of physical and emotional symptoms, including sweating, trembling, tachycardia, and disturbances in sleep patterns. These symptoms vary in intensity and frequency but are generally disruptive and distressing.
Individuals with anxiety often experience a range of physical and emotional symptoms, including sweating, trembling, tachycardia, and disturbances in sleep patterns. These symptoms vary in intensity and frequency but are generally disruptive and distressing.
1.1K
01:22Autonomic Nervous System
12.9K
The autonomic nervous system (ANS) is a critical component of the peripheral nervous system, primarily responsible for regulating involuntary bodily functions and maintaining homeostasis. It functions in tandem with the central nervous system (CNS) to seamlessly coordinate various physiological processes without the need for conscious control.
The ANS comprises two main divisions: the sympathetic and parasympathetic divisions. These divisions function antagonistically to maintain a dynamic...
The ANS comprises two main divisions: the sympathetic and parasympathetic divisions. These divisions function antagonistically to maintain a dynamic...
12.9K
01:30Generalized Anxiety Disorder
727
Generalized Anxiety Disorder (GAD) is a chronic condition characterized by excessive and uncontrollable worry that persists for at least six months, significantly interfering with daily functioning. Unlike situational anxiety, which arises in response to specific stressors, GAD often occurs without a clear cause. Individuals may experience disproportionate worry about work, health, or relationships. For instance, a person might continuously fear poor health despite normal medical evaluations or...
727
01:28Social Anxiety Disorder
538
Social anxiety disorder, also known as social phobia, is characterized by an intense fear of social situations where one might face humiliation, rejection, embarrassment, or negative evaluation. This disorder leads individuals to avoid activities like casual conversations, public speaking, or seemingly simple tasks such as eating, signing documents, or swimming, in public settings. Its impact extends beyond discomfort, often significantly interfering with daily functioning and quality of life.
538
01:26Autonomic Nervous System: Overview
7.5K
The human nervous system is divided into two main parts: the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS is composed of the brain and spinal cord, while the PNS contains nerve cells, clusters of nerve cells, and the sensory receptors that are outside the CNS. The PNS has two types of nerve cells: sensory (afferent) and motor (efferent). Sensory cells send signals to the CNS from receptors, and motor cells carry signals from the CNS to organs, muscles, and...
7.5K
01:18Disorders of the Autonomic Nervous System
1.6K
The autonomic nervous system (ANS) is an intricate network of nerves that controls functions such as the regulation of heart rate, digestion, and blood pressure regulation. When this system malfunctions, it can lead to various disorders that affect multiple bodily functions. One common feature of many autonomic disorders is the involvement of smooth blood vessels, which play a crucial role in regulating blood flow throughout the body.
Raynaud's disease, also known as Raynaud's...
Raynaud's disease, also known as Raynaud's...
1.6K