Orthostatic hypotension-induced autonomic dysreflexia

Area of Science:

• Neurology
• Autonomic Neuroscience

Background:

• Chronic traumatic cervical myelopathy can lead to autonomic dysfunction.
• Orthostatic intolerance is a common complication in spinal cord injury patients.

Observation:

• Three patients with cervical myelopathy presented with severe orthostatic hyperhidrosis.
• Orthostatic challenge revealed hypotension preceded autonomic dysreflexia symptoms like hyperhidrosis, hypertension, and chills.

Findings:

• Orthostatic hypotension appears to be a trigger for autonomic dysreflexia in this patient group.
• Fludrocortisone acetate effectively treated both orthostatic hypotension and autonomic dysreflexia symptoms.

Implications:

• Current management of propping patients upright may exacerbate autonomic dysreflexia.
• This finding necessitates a re-evaluation of autonomic dysreflexia management strategies in cervical myelopathy.
• Targeting orthostatic hypotension could be a novel therapeutic approach for autonomic dysreflexia.