Assessment of autonomic dysreflexia in patients with spinal cord injury.

Details

Serval ID
serval:BIB_696CE341FD3F
Type
Article: article from journal or magazin.
Collection
Publications
Title
Assessment of autonomic dysreflexia in patients with spinal cord injury.
Journal
Journal of Neurology, Neurosurgery, and Psychiatry
Author(s)
Curt A., Nitsche B., Rodic B., Schurch B., Dietz V.
ISSN
0022-3050 (Print)
ISSN-L
0022-3050
Publication state
Published
Issued date
1997
Volume
62
Number
5
Pages
473-477
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Abstract
OBJECTIVES AND METHODS: To assess the impairment of supraspinal control over spinal sympathetic centres and the occurrence of autonomic dysreflexia in patients with spinal cord injury. Autonomic dysreflexia is caused by the disconnection of spinal sympathetic centres from supraspinal control and is characterised by paroxysmal hypertensive episodes caused by non-specific stimuli below the level of the lesion. Therefore, patients with spinal cord injury were examined clinically and by different techniques to assess the occurrence of autonomic dysreflexia and to relate disturbances of the sympathetic nervous system to episodes of autonomic dysreflexia.
RESULTS: None of the paraplegic patients, but 59% (13/22) of tetraplegic patients (91% of the complete, 27% of the incomplete patients) presented signs of autonomic dysreflexia during urodynamic examination. Only 62% of the tetraplegic patients complained about symptoms of autonomic dysreflexia. Pathological sympathetic skin responses (SSRs) of the hands were related to signs of autonomic dysreflexia in 93% of cases. No patient with preserved SSR potentials of the hands and feet showed signs of autonomic dysreflexia, either clinically or during urodynamic examination. Ambulatory blood pressure measurements (ABPMs) indicated a loss of circadian blood pressure rhythm (sympathetic control) but preserved heart rate rhythm (parasympathetic regulation) only in patients with complete tetraplegia. Pathological ABPM recordings were seen in 70% of patients with symptoms of autonomic dysreflexia.
CONCLUSIONS: The urodynamic examination was more sensitive in indicating signs of autonomic dysreflexia in patients with spinal cord injury, whereas SSR allowed the assessment of the degree of disconnection of the sympathetic spinal centres from supraspinal control. Using ABPM recordings the occurrence of episodes of autonomic dysreflexia over 24 hours and the effectiveness of therapeutical treatment can be assessed.
Keywords
Adolescent, Adult, Autonomic Nervous System Diseases/diagnosis, Autonomic Nervous System Diseases/etiology, Blood Pressure, Circadian Rhythm, Female, Galvanic Skin Response, Heart Rate, Humans, Male, Middle Aged, Paraplegia/etiology, Periodicity, Quadriplegia/etiology, Reflex, Retrospective Studies, Spinal Cord Injuries/complications, Urodynamics
Pubmed
Web of science
Create date
05/11/2014 12:12
Last modification date
20/08/2019 14:24
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