Related Experiment Videos
Autonomic dysreflexia after brainstem tumor resection. A case report
1Department of Physical Medicine and Rehabilitation, University Hospital, London, Ontario, Canada.
American Journal of Physical Medicine & Rehabilitation
|December 1, 1993
Summary
Autonomic dysreflexia, usually seen in spinal cord injury, can occur after brainstem surgery. A gastric ulcer triggered this condition in a patient with diminished sympathetic outflow, highlighting medullary sympathetic control.
Area of Science:
- Neuroscience
- Autonomic Nervous System Research
- Clinical Neurology
Background:
- Autonomic dysreflexia (AD) is a potentially life-threatening condition typically associated with spinal cord injury.
- It presents with sudden, severe hypertension, bradycardia, headache, and sweating above the lesion level.
- The exact mechanisms and triggers outside of spinal cord injury are not fully understood.
Observation:
- An 18-year-old male experienced autonomic failure post-surgery for a fourth ventricle hemangioblastoma near the area postrema.
- He later developed recurrent episodes of abdominal pain, hypertension, flushing, and headaches.
- A gastric ulcer was identified as the likely trigger for these autonomic dysreflexia episodes.
Findings:
- The patient's symptoms significantly improved after treatment of the gastric ulcer.
- This suggests that diminished sympathetic outflow from the brainstem surgery rendered the patient susceptible to AD.
- Noxious stimuli, such as a gastric ulcer, can elicit AD in the presence of compromised supraspinal sympathetic control.
Implications:
- This case suggests that autonomic dysreflexia may occur unrecognized in patients following brainstem tumor resection.
- It highlights the medulla or higher brainstem levels as crucial for sympathetic supraspinal control.
- Further research is warranted to identify and manage AD in non-spinal cord injury populations.