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Development of an Algorithm to Perform a Comprehensive Study of Autonomic Dysreflexia in Animals with High Spinal Cord Injury Using a Telemetry Device
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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
PubMed
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.

Keywords:
AnxietyAutonomic dysreflexiaBlood pressureRehabilitationSpinal cord injury

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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.