Latent Autonomic Dysfunction in a Chronic Cervical Spinal Injury

Latent autonomic dysfunction has been identified in recent years among patients with chronic cervical lesions. This paper further illustrates a precautionary case of symptomatic manifestation with an elusive trigger. A 64-year-old male, who had shown excellent neurological recovery after decompression surgery for a cervical spinal injury (modified Frankel classification from C1 to D3), complained of recurrent syncope in the chronic phase. The cause remained unidentified for two years, but it was finally discovered that the syncope was induced by a transient sympathetic overactivation that was concurrent with mental strain and alcohol intake. Abstinence completely suppressed the episodes thereafter. The case suggests the possibility that patients with a history of cervical spinal injury, no matter how normal they appear, may have asymptomatic autonomic dysfunction. Additionally, identification of the trigger can be challenging due to its dynamic and protean nature. More emphasis should be paid to autonomic evaluation for chronic cervical spinal injuries.