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Liao YW, Ensam B, Kodamanchile A, Duckett S. Spinal abscess in a patient with undiagnosed Gerbode defect: a case report. Eur Heart J Case Rep 2021; 5:ytab358. [PMID: 34661052 PMCID: PMC8517886 DOI: 10.1093/ehjcr/ytab358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022]
Abstract
Background Gerbode defect (GD) is a rare cardiac defect in which an abnormal communication occurs between the left ventricle and right atrium. The aetiology is usually congenital but acquired defects can occur. Case summary We report on a 47-year-old male with atrioventricular block prior to decompression of an epidural abscess extending from the skull base to the 7th thoracic vertebrae. Following positive blood cultures for Staphylococcus aureus, a transoesophageal echocardiogram performed revealed a small GD with associated endocarditis. In our case, the defect was small and there was no evidence of heart failure, there was little guidance or literature available on how to best manage our patient. A multidisciplinary decision was taken to treat the endocarditis medically and to not close the defect in the acute setting. He recovered well and did not suffer any further cardiac complications. A repeat transthoracic echocardiogram did not reveal any evidence of endocarditis. Conclusion Gerbode defects are rare but have been known to increase the risk of developing endocarditis. It is important to have a high clinical suspicion of endocarditis in patients with evidence of conduction disorders and systemic infection.
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Affiliation(s)
- Yuen Wei Liao
- Department of Cardiovascular Medicine and Science, University Hospitals of North Midlands, Newcastle Road, Stoke-on-Trent ST4 6QG, UK
| | - Bode Ensam
- Department of Cardiovascular Medicine and Science, University Hospitals of North Midlands, Newcastle Road, Stoke-on-Trent ST4 6QG, UK
| | - Aaditya Kodamanchile
- Department of Cardiovascular Medicine and Science, University Hospitals of North Midlands, Newcastle Road, Stoke-on-Trent ST4 6QG, UK
| | - Simon Duckett
- Department of Cardiovascular Medicine and Science, University Hospitals of North Midlands, Newcastle Road, Stoke-on-Trent ST4 6QG, UK
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Małek ŁA, Mróz A, Czajkowska A, Kosmol A, Ogonowska-Słodownik A, Molik B, Morgulec-Adamowicz N. Accuracy of Impedance Cardiography for Hemodynamic Assessment During Rest and Exercise in Wheelchair Rugby Players. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2019; 90:336-343. [PMID: 31082312 DOI: 10.1080/02701367.2019.1600651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/24/2019] [Indexed: 06/09/2023]
Abstract
Purpose: The aim of the study was to analyze the accuracy of impedance cardiography (ICG) for hemodynamic assessment in wheelchair rugby players during rest and exercise. Method: The study included 21 players (mean age 33.0 ± 5.4, 86% male) with posttraumatic tetraplegia. ECG, echocardiography, and gas exchange analysis during rest and exercise were used to obtain heart rate (HR), stroke volume (SV), and cardiac output (CO) for comparison with PhysioFlow®. Results: There was a good correlation between reference methods and ICG for HR, SV, CO at rest and CO at peak exercise (r = 0.69-0.77, p < .001) and a very good correlation for peak HR (r = 0.91, p < .0001). ICG overestimated SV at rest, CO at rest, and peak CO, which resulted in low intraclass correlation coefficients (ICC = 0.250 and 0.570). Conclusions: ICG can serve as a good estimate of basic hemodynamic parameters during rest and exercise in wheelchair rugby players but overestimates stroke volume and cardiac output.
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Affiliation(s)
- Łukasz A Małek
- a Józef Pilsudski University of Physical Education in Warsaw
| | - Anna Mróz
- a Józef Pilsudski University of Physical Education in Warsaw
| | - Anna Czajkowska
- a Józef Pilsudski University of Physical Education in Warsaw
| | - Andrzej Kosmol
- a Józef Pilsudski University of Physical Education in Warsaw
| | | | - Bartosz Molik
- a Józef Pilsudski University of Physical Education in Warsaw
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Soluble TNFα Signaling within the Spinal Cord Contributes to the Development of Autonomic Dysreflexia and Ensuing Vascular and Immune Dysfunction after Spinal Cord Injury. J Neurosci 2018; 38:4146-4162. [PMID: 29610439 DOI: 10.1523/jneurosci.2376-17.2018] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 03/08/2018] [Accepted: 03/14/2018] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular disease and susceptibility to infection are leading causes of morbidity and mortality for individuals with spinal cord injury (SCI). A major contributor to these is autonomic dysreflexia (AD), an amplified reaction of the autonomic nervous system (hallmarked by severe hypertension) in response to sensory stimuli below the injury. Maladaptive plasticity of the spinal sympathetic reflex circuit below the SCI results in AD intensification over time. Mechanisms underlying this maladaptive plasticity are poorly understood, restricting the identification of treatments. Thus, no preventative treatments are currently available. Neuroinflammation has been implicated in other pathologies associated with hyperexcitable neural circuits. Specifically, the soluble form of TNFα (sTNFα) is known to play a role in neuroplasticity. We hypothesize that persistent expression of sTNFα in spinal cord underlies AD exacerbation. To test this, we intrathecally administered XPro1595, a biologic that renders sTNFα nonfunctional, after complete, high-level SCI in female rats. This dramatically attenuated the intensification of colorectal distension-induced and naturally occurring AD events. This improvement is mediated via decreased sprouting of nociceptive primary afferents and activation of the spinal sympathetic reflex circuit. We also examined peripheral vascular function using ex vivo pressurized arterial preparations and immune function via flow cytometric analysis of splenocytes. Diminishing AD via pharmacological inhibition of sTNFα mitigated ensuing vascular hypersensitivity and immune dysfunction. This is the first demonstration that neuroinflammation-induced sTNFα is critical for altering the spinal sympathetic reflex circuit, elucidating a novel mechanism for AD. Importantly, we identify the first potential pharmacological, prophylactic treatment for this life-threatening syndrome.SIGNIFICANCE STATEMENT Autonomic dysreflexia (AD), a disorder that develops after spinal cord injury (SCI) and is hallmarked by sudden, extreme hypertension, contributes to cardiovascular disease and susceptibility to infection, respectively, two leading causes of mortality and morbidity in SCI patients. We demonstrate that neuroinflammation-induced expression of soluble TNFα plays a critical role in AD, elucidating a novel underlying mechanism. We found that intrathecal administration after SCI of a biologic that inhibits soluble TNFα signaling dramatically attenuates AD and significantly reduces AD-associated peripheral vascular and immune dysfunction. We identified mechanisms behind diminished plasticity of neuronal populations within the spinal sympathetic reflex circuit. This study is the first to pinpoint a potential pharmacological, prophylactic strategy to attenuate AD and ensuing cardiovascular and immune dysfunction.
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Dance DL, Chopra A, Campbell K, Ditor DS, Hassouna M, Craven BC. Exploring daily blood pressure fluctuations and cardiovascular risk among individuals with motor complete spinal cord injury: a pilot study. J Spinal Cord Med 2017; 40:405-414. [PMID: 27813450 PMCID: PMC5537957 DOI: 10.1080/10790268.2016.1236161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Clinically silent autonomic dysfunction with bowel and bladder care, are postulated to contribute to cardiovascular disease after chronic spinal cord injury (SCI). OBJECTIVE We describe the frequency and severity of dysreflexic episodes, termed transient blood pressure elevations (T-BPE) over 48 hours in adults with cervical or high-thoracic motor-complete SCI. SETTING Tertiary SCI Rehabilitation Centre in Toronto, Canada. PARTICIPANTS Individuals with chronic SCI, C1-T3 AIS A or B, >1 year post-injury, living in the community (n=19). OUTCOME MEASURES Data were obtained via 48-hour ambulatory blood pressure (BP) and heart rate (HR) monitoring, with data captured at 10-minute intervals and a concurrent diary describing activities of daily living, and bladder/bowel routines. T-BPE were defined as a ≥ 40 mmHg elevation in systolic blood pressure (SBP) above the participant's supine baseline. Severe (≥ 60-79 mmHg) and Extreme ≥80 mmHg elevations in SBP were described. RESULTS Thirteen participants experienced T-BPE within the assessment period, with 7/13 experiencing "severe", and 3/13 experiencing "extreme" SBP elevations. The median number of T-BPE was 8 (IQR = 3), and the mean ± SD SBP during T-BPE was 150 ± 16 mmHg, These T-BPE were verified as dysreflexic events using a conservative definition of a >40 mmHg increase in SBP, with a concurrent 10 bpm decrease in HR, above the 48-hour average SBP, yielding 12/19 participants with T-BPE. CONCLUSIONS T-BPE were frequent, often with severe or extreme elevations in SBP, despite few reported symptoms. Recognition and management of these dysreflexic events associated with T-BPE are needed, which may ameliorate cardiovascular disease risk.
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Affiliation(s)
- Derry L. Dance
- Department of Medicine, University of Toronto, Toronto, ON, Canada,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Amit Chopra
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Kent Campbell
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David S. Ditor
- Department of Physical Education and Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Magdy Hassouna
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - B. Catharine Craven
- Department of Medicine, University of Toronto, Toronto, ON, Canada,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Correspondence to: B. Catharine Craven, Lyndhurst Centre, Toronto Rehabilitation Institute-UHN 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada.
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Handrakis JP, Rosado-Rivera D, Singh K, Swonger K, Azarelo F, Lombard AT, Spungen AM, Kirshblum SC, Bauman WA. Self-reported effects of cold temperature exposure in persons with tetraplegia. J Spinal Cord Med 2017; 40:389-395. [PMID: 27077570 PMCID: PMC5537955 DOI: 10.1080/10790268.2016.1154670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Cervical spinal cord injury (tetraplegia) is known to interrupt sympathetic vasculature control, thereby preventing shunting of blood from the periphery to central organs when exposed to cold temperatures. As a result, persons with tetraplegia are at risk to develop hypothermia. However, information regarding the discomfort experienced during the cooler months (late fall, winter, early spring) is overwhelmingly anecdotal. It is not known, with any certainty, how those with tetraplegia perceive cold and if discomfort in colder environments restricts them from performing activities that they routinely would perform. DESIGN Prospective, two-group, self-report surveys. SETTING VA Medical Center and Kessler Institute for Rehabilitation. PARTICIPANTS Forty-four subjects with tetraplegia; 41 matched non-SCI controls. OUTCOME MEASURES Tetraplegic and control groups responded "yes" or "no" when asked whether cold seasonal temperatures allowed comfort or negatively affected participation in routine activities. RESULTS Percentage of responses of tetraplegia compared to controls was different as to whether they felt cold when others in the same room were comfortable (82 vs. 24%; χ2 = 28.2, P < 0.0001), felt comfortable outdoors (17 vs. 43%; χ2 = 6.8, P = 0.009), or whether cold negatively affected bathing routines (55 vs. 15%; χ2 = 14.8, P = 0.0001), keeping physician appointments (46 vs. 12%; χ2 = 11.3, P = 0.0008), thinking clearly (41 vs. 7%; χ2 = 12.9, P = 0.0003), and completing usual work duties (46 vs. 10%; χ2 = 13.3, P = 0.0003). CONCLUSION Cold seasonal temperatures have a reported greater negative impact on personal comfort and ability to perform vital activities in persons with tetraplegia than that of non-SCI controls. These findings highlight the need to address thermoregulatory impairment in persons with tetraplegia.
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Affiliation(s)
- John P. Handrakis
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA,New York Institute of Technology, Department of Physical Therapy, School of Health Professions, Old Westbury, NY, USA,Correspondence to: John Handrakis, National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, 130 West Kingsbridge Road, 7A-13, Bronx, NY 10468, USA. E-mail:
| | - Dwindally Rosado-Rivera
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Kamaldeep Singh
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Kirsten Swonger
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Frank Azarelo
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Alex T. Lombard
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA
| | - Ann M. Spungen
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA,Medical Service, James J. Peters VA Medical Center, Bronx, NY, USA,Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven C. Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - William A. Bauman
- VA RR&D National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY, USA,Medical Service, James J. Peters VA Medical Center, Bronx, NY, USA,Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA,Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
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6
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Lee YH, Lee JH, Kim SH, Yi D, Oh KJ, Kim JH, Park TJ, Kim H, Chang JS, Kong ID. Hemodynamic Adaptations to Regular Exercise in People With Spinal Cord Injury. Ann Rehabil Med 2017; 41:25-33. [PMID: 28289632 PMCID: PMC5344823 DOI: 10.5535/arm.2017.41.1.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/14/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the real-time cardiovascular response to the progressive overload exercise in different levels of spinal cord injury (SCI), and to find out whether regular exercise has effect on these cardiovascular responses. Methods The study enrolled 8 able-bodied individuals in the control group plus 15 SCI subjects who were divided into two groups by their neurological level of injury: high-level SCI group (T6 or above) and low-level SCI group (T7 or below). Also, subjects were divided into exercise group and non-exercise group by usual exercise habits. We instructed the subjects to perform exercises using arm ergometer according to the protocol and checked plethysmograph for the real time assessment of blood pressure, heart rate, and cardiac output. Results Six subjects were included in high-level SCI group (3 cervical, 3 thoracic injuries), 9 subjects in low-level SCI group (9 thoracic injuries), and 8 able-bodied individuals in control group. During arm ergometer-graded exercise, mean arterial pressure (MAP) was significantly lower in high-level SCI subjects of non-exercise group, compared with high-level SCI subjects of exercise group. In addition, HR was significantly higher in low-level SCI group compared with control group. Conclusion There are significant differences in mean arterial pressure of high-level SCI group according to usual exercise habits. We discovered that even in non-athlete high-level SCI, regular exercise can bring cardiac modulation through blood pressure control.
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Affiliation(s)
- Young Hee Lee
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.; Center for Exercise Medicine, Yonsei University, Wonju, Korea
| | - Jin Hyeong Lee
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Hoon Kim
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dongsoo Yi
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kyung Joon Oh
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji Hyun Kim
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Tae Jun Park
- Department of Rehabilitation Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hanul Kim
- Center for Exercise Medicine, Yonsei University, Wonju, Korea
| | - Jae Seung Chang
- Center for Exercise Medicine, Yonsei University, Wonju, Korea
| | - In Deok Kong
- Center for Exercise Medicine, Yonsei University, Wonju, Korea.; Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, Korea
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Wilsey B, Marcotte TD, Deutsch R, Zhao H, Prasad H, Phan A. An Exploratory Human Laboratory Experiment Evaluating Vaporized Cannabis in the Treatment of Neuropathic Pain From Spinal Cord Injury and Disease. THE JOURNAL OF PAIN 2016; 17:982-1000. [PMID: 27286745 PMCID: PMC5007175 DOI: 10.1016/j.jpain.2016.05.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/18/2016] [Accepted: 05/20/2016] [Indexed: 12/14/2022]
Abstract
UNLABELLED Using 8-hour human laboratory experiments, we evaluated the analgesic efficacy of vaporized cannabis in patients with neuropathic pain related to injury or disease of the spinal cord, most of whom were experiencing pain despite traditional treatment. After obtaining baseline data, 42 participants underwent a standardized procedure for inhaling 4 puffs of vaporized cannabis containing either placebo, 2.9%, or 6.7% delta 9-THC on 3 separate occasions. A second dosing occurred 3 hours later; participants chose to inhale 4 to 8 puffs. This flexible dosing was used to attempt to reduce the placebo effect. Using an 11-point numerical pain intensity rating scale as the primary outcome, a mixed effects linear regression model showed a significant analgesic response for vaporized cannabis. When subjective and psychoactive side effects (eg, good drug effect, feeling high, etc) were added as covariates to the model, the reduction in pain intensity remained significant above and beyond any effect of these measures (all P < .0004). Psychoactive and subjective effects were dose-dependent. Measurement of neuropsychological performance proved challenging because of various disabilities in the population studied. Because the 2 active doses did not significantly differ from each other in terms of analgesic potency, the lower dose appears to offer the best risk-benefit ratio in patients with neuropathic pain associated with injury or disease of the spinal cord. PERSPECTIVE A crossover, randomized, placebo-controlled human laboratory experiment involving administration of vaporized cannabis was performed in patients with neuropathic pain related to spinal cord injury and disease. This study supports consideration of future research that would include longer duration studies over weeks to months to evaluate the efficacy of medicinal cannabis in patients with central neuropathic pain.
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Affiliation(s)
- Barth Wilsey
- VA Northern California Health Care System Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655 USA, 916-843-7000 | 800-382-8387
- Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Sacramento, CA 95817 USA
| | - Thomas D. Marcotte
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Street, Suite B, MC8231, San Diego, CA 92103-8231 USA
| | - Reena Deutsch
- Department of Psychiatry, University of California, San Diego, 220 Dickinson Street, Suite B, MC8231, San Diego, CA 92103-8231 USA
| | - Holly Zhao
- VA Northern California Health Care System Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655 USA, 916-843-7000 | 800-382-8387
- Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Sacramento, CA 95817 USA
| | - Hannah Prasad
- VA Northern California Health Care System Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655 USA, 916-843-7000 | 800-382-8387
- Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Sacramento, CA 95817 USA
| | - Amy Phan
- VA Northern California Health Care System Sacramento VA Medical Center, 10535 Hospital Way, Mather, CA 95655 USA, 916-843-7000 | 800-382-8387
- Department of Physical Medicine and Rehabilitation, University of California, Davis Medical Center, Lawrence J. Ellison Ambulatory Care Center, 4860 Y Street, Sacramento, CA 95817 USA
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8
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West CR, Krassioukov AV. Autonomic cardiovascular control and sports classification in Paralympic athletes with spinal cord injury. Disabil Rehabil 2016; 39:127-134. [DOI: 10.3109/09638288.2015.1118161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Christopher R. West
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
- G. F. Strong Rehab Centre, Vancouver, BC, Canada
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9
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Abstract
Spinal cord injury (SCI) results not only in motor and sensory deficits but also in autonomic dysfunctions. The disruption of connections between higher brain centers and the spinal cord, or the impaired autonomic nervous system itself, manifests a broad range of autonomic abnormalities. This includes compromised cardiovascular, respiratory, urinary, gastrointestinal, thermoregulatory, and sexual activities. These disabilities evoke potentially life-threatening symptoms that severely interfere with the daily living of those with SCI. In particular, high thoracic or cervical SCI often causes disordered hemodynamics due to deregulated sympathetic outflow. Episodic hypertension associated with autonomic dysreflexia develops as a result of massive sympathetic discharge often triggered by unpleasant visceral or sensory stimuli below the injury level. In the pelvic floor, bladder and urethral dysfunctions are classified according to upper motor neuron versus lower motor neuron injuries; this is dependent on the level of lesion. Most impairments of the lower urinary tract manifest in two interrelated complications: bladder storage and emptying. Inadequate or excessive detrusor and sphincter functions as well as detrusor-sphincter dyssynergia are examples of micturition abnormalities stemming from SCI. Gastrointestinal motility disorders in spinal cord injured-individuals are comprised of gastric dilation, delayed gastric emptying, and diminished propulsive transit along the entire gastrointestinal tract. As a critical consequence of SCI, neurogenic bowel dysfunction exhibits constipation and/or incontinence. Thus, it is essential to recognize neural mechanisms and pathophysiology underlying various complications of autonomic dysfunctions after SCI. This overview provides both vital information for better understanding these disorders and guides to pursue novel therapeutic approaches to alleviate secondary complications.
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Affiliation(s)
- Shaoping Hou
- Spinal Cord Research Center, Department of Neurobiology & Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
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10
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Abstract
Context Autonomic dysreflexia (AD) is a life-threatening complication of chronic traumatic spinal cord injury (SCI). Objective To document and provide insight into the life-threatening sequelae associated with AD. Methods A review was conducted to identify literature which documented cases of AD associated with life-threatening outcomes (and death). The search strategy comprised of a keyword search on the PubMed database as well as manual searches of retrieved articles. Outcomes were categorized into three main classes: central nervous system (CNS), cardiovascular (CV), and pulmonary. Results Thirty-two cases of death or life-threatening complications of AD were found. Twenty-three (72%) cases were CNS-related, seven (22%) cases were CV-related, and two (6%) cases were pulmonary-related. In total, seven (22%) deaths were noted as a direct result of complications following an AD attack. Conclusion AD is a well-known consequence of SCI among individuals with high thoracic and cervical injuries. Many of these individuals experience this condition on a daily basis. Medical personnel, care givers, and individuals with SCI should be aware of the importance of timely diagnosis and management of this life-threatening condition, which can result in a variety of significant complications including stroke, seizures, myocardial ischemia, and death.
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Affiliation(s)
- Darryl Wan
- Department of Medicine, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Andrei V. Krassioukov
- Correspondence to: Andrei Krassioukov, Department of Medicine, International Collaboration on Repair Discoveries, University of British Columbia 818 West 10th Avenue, Vancouver, BC, Canada V5Z 1M9.
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11
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Hou S, Lu P, Blesch A. Characterization of supraspinal vasomotor pathways and autonomic dysreflexia after spinal cord injury in F344 rats. Auton Neurosci 2013; 176:54-63. [DOI: 10.1016/j.autneu.2013.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 01/03/2013] [Accepted: 02/01/2013] [Indexed: 12/26/2022]
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12
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Mills PB, Krassioukov A. Autonomic function as a missing piece of the classification of Paralympic athletes with spinal cord injury. Spinal Cord 2011; 49:768-76. [DOI: 10.1038/sc.2011.2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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13
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Garstang SV, Miller-Smith SA. Autonomic Nervous System Dysfunction After Spinal Cord Injury. Phys Med Rehabil Clin N Am 2007; 18:275-96, vi-vii. [PMID: 17543773 DOI: 10.1016/j.pmr.2007.02.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The autonomic nervous system (ANS) plays a key role in the regulation of many physiologic processes, mediated by supraspinal control from centers in the central nervous system. The role of autonomic dysfunction in persons with spinal cord injuries is crucial to understand because many aspects of the altered physiology seen in these individuals are directly caused by ANS dysregulation.
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Affiliation(s)
- Susan V Garstang
- Department of Physical Medicine and Rehabilitation, UMNDJ-New Jersey Medical School, 30 Bergen Street, ADMC 101, Newark, NJ 07039, USA.
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