Autonomic dysreflexia in patient after spinal cord injury
Authors:
Vladimír Šámal 1,2; Jan Mečl 1
Authors‘ workplace:
Urologické oddělení, Krajská nemocnice Liberec, a. s.
1; Urologická klinika Fakultní nemocnice a Lékařské fakulty UK, Hradec Králové
2
Published in:
Ces Urol 2014; 18(4): 279-287
Category:
Review article
Overview
Autonomic dysreflexia is a consequence of dysfunction of the autonomic nervous system following spinal cord injury, which leads also to interruption of sympathetic nerve pathways in the spinal cord due to an accident. The autonomic dysreflexia occurs in patients with injuries above the spinal segment T6. It is caused by an imbalance between the sympathetic and parasympathetic nervous systems. Autonomic dysreflexia can be triggered by a number of physiological or pathological sensations from the area under the spinal cord lesion. It is characterized by paroxysmal hypertension accompanied by bradycardia and headaches. The aim of this communication is to provide urologists with current and comprehensive knowledge of the pathogenesis, clinical manifestations and evidence-based treatment of autonomic dysreflexia.
Key words:
autonomic dysreflexia, spinal cord injury, autonomic nervous system, tetraplegia.
Sources
1. DeVivo MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil 1999; 80(11): 1411–1419.
2. Garshick E, Kelley A, Cohen SA, Garrison A, Tun CG, Gagnon D, et al. A prospective assessment of mortality in chronic spinal cord injury. Spinal Cord 2005; 43(7): 408–416.
3. Popa C, Popa F, Grigorean VT, Onose G, Sandu AM, Popescu M, et al. Vascular dysfunctions following spinal cord injury. J Med Life 2010; 3(3): 275–285.
4. Guttmann L,Whitteridge D. Effects of bladder distension on autonomic mechanisms after spinal cord injuries. Brain 1947; 70(Pt 4): 361–404.
5. Krhut J, Zachoval R. Neurální kontrola dolních močových cest. Ces Urol 2011; 15(2): 69–77.
6. Krassioukov AV, Karlsson AK, Wecht JM, Wuermser LA, Mathias CJ, Marino RJ. Assessment of autonomic dysfunction following spinal cord injury: rationale for additions to International Standards for Neurological Assessment. J Rehabil Res Dev 2007; 44(1): 103–112.
7. Krassioukov AV, Warburton DE, Teasell R, Eng JJ. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil 2009; 90(4): 682–695.
8. Elliott S, Krassioukov A. Malignant autonomic dysreflexia in spinal cord injured men. Spinal Cord 2006; 44(6): 386–392.
9. Krassioukov AV, Furlan JC, Fehlings MG. Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity. J Neurotrauma 2003; 20(8): 707–716.
10. Curt A, Nitsche B, Rodic B, Schurch B, Dietz V. Assessment of autonomic dysreflexia in patients with spinal cord injury. J Neurol Neurosurg Psychiatry 1997; 62(5): 473–477.
11. Silver JR. Early autonomic dysreflexia. Spinal Cord 2000; 38(4): 229–233.
12. Giannantoni A, Di Stasi SM, Scivoletto G, Mollo A, Silecchia A, Fuoco U, et al. Autonomic dysreflexia during urodynamics. Spinal Cord 1998; 36(11): 756–760.
13. Dykstra DD, Sidi AA, Anderson LC. The effect of nifedipine on cystoscopy-induced autonomic hyperreflexia in patients with high spinal cord injuries. J Urol 1987; 138(5): 1155–1157.
14. Liu N, Fougere R, Zhou MW, Nigro MK, Krassioukov AV. Autonomic dysreflexia severity during urodynamics and cystoscopy in individuals with spinal cord injury. Spinal Cord 2013; 51(11): 863–867.
15. Giannantoni A, Di Stasi SM, Stephen RL, Navarra P, Scivoletto G, Mearini E, et al. Intravesical capsaicin versus resiniferatoxin in patients with detrusor hyperreflexia: a prospective randomized study. J Urol 2002; 167(4): 1710–1714.
16. Cosman BC, Vu TT. Lidocaine anal block limits autonomic dysreflexia during anorectal procedures in spinal cord injury: a randomized, double-blind, placebo-controlled trial. Dis Colon Rectum 2005; 48(8): 1556–1561.
17. Cosman BC, Vu TT, Plowman BK. Topical lidocaine does not limit autonomic dysreflexia during anorectal procedures in spinal cord injury: a prospective, double-blind study. Int J Colorectal Dis 2002; 17(2): 104–108.
18. Matthews JM, Wheeler GD, Burnham RS, Malone LA, Steadward RD. The effects of surface anaesthesia on the autonomic dysreflexia response during functional electrical stimulation. Spinal Cord 1997; 35(10): 647–651.
19. Krum H, Louis WJ, Brown DJ, Howes LG. A study of the alpha-1 adrenoceptor blocker prazosin in the prophylactic management of autonomic dysreflexia in high spinal cord injury patients. Clin Auton Res 1992; 2(2): 83–88.
20. Sheel AW, Krassioukov AV, Inglis JT, Elliott SL. Autonomic dysreflexia during sperm retrieval in spinal cord injury: influence of lesion level and sildenafil citrate. J Appl Physiol (1985) 2005; 99(1): 53–58.
21. Acute management of autonomic dysreflexia: individuals with spinal cord injury presenting to health-care facilities. J Spinal Cord Med 2002; 25(Suppl 1): S67–88.
22. Claydon VE, Steeves JD, Krassioukov AV. Orthostatic hypotension following spinal cord injury: understanding clinical pathophysiology. Spinal Cord 2006; 44(6): 341–351.
23. Steinberger RE, Ohl DA, Bennett CJ, McCabe M, Wang SC. Nifedipine pretreatment for autonomic dysreflexia during electroejaculation. Urology 1990; 36(3): 228–231.
24. Thyberg M, Ertzgaard P, Gylling M, Granerus G. Effect of nifedipine on cystometry-induced elevation of blood pressure in patients with a reflex urinary bladder after a high level spinal cord injury. Paraplegia 1994; 32(5): 308–313.
25. Kabalin JN, Lennon S, Gill HS, Wolfe V, Perkash I. Incidence and management of autonomic dysreflexia and other intraoperative problems encountered in spinal cord injury patients undergoing extracorporeal shock wave lithotripsy without anesthesia on a second generation lithotriptor. J Urol 1993; 149(5): 1064–1067.
26. Grossman E, Messerli FH, Grodzicki T, Kowey P. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA 1996; 276(16): 1328–1331.
27. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157(21): 2413–2446.
28. Ravindran RS, Cummins DF, Smith IE. Experience with the use of nitroprusside and subsequent epidural analgesia in a pregnant quadriplegic patient. Anesth Analg 1981; 60(1): 61–63.
29. Esmail Z, Shalansky KF, Sunderji R, Anton HA, Chambers K, Fish W. Evaluation of captopril for the management of hypertension in autonomic dysreflexia: a pilot study. Arch Phys Med Rehabil 2002; 83(5): 604–608.
30. Anton HA, Townson A. Drug therapy for autonomic dysreflexia. CMAJ 2004; 170(8): 1210.
31. Linsenmeyer TA, Campagnolo DI, Chou IH. Silent autonomic dysreflexia during voiding in men with spinal cord injuries. J Urol 1996; 155(2): 519–522.
32. Cruz F, Herschorn S, Aliotta P, Brin M, Thompson C, Lam W, et al. Efficacy and safety of onabotulinumtoxinA in patients with urinary incontinence due to neurogenic detrusor overactivity: a randomised, double-blind, placebo-controlled trial. Eur Urol 2011; 60(4): 742–750.
33. Schurch B, Stohrer M, Kramer G, Schmid DM, Gaul G, Hauri D. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 2000; 164(3 Pt 1): 692–697.
34. Dykstra DD, Sidi AA, Scott AB, Pagel JM, Goldish GD. Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol 1988; 139(5): 919–922.
35. Igawa Y, Satoh T, Mizusawa H, Seki S, Kato H, Ishizuka O, et al. The role of capsaicin-sensitive afferents in autonomic dysreflexia in patients with spinal cord injury. BJU Int 2003; 91(7): 637–641.
36. Hohenfellner M, Pannek J, Bote lU, Dahms S, Pfitzenmaier J, Fichtner J, et al. Sacral bladder denervation for treatment of detrusor hyperreflexia and autonomic dysreflexia. Urology 2001; 58(1): 28–32.
37. Schurch B, Knapp PA, Jeanmonod D, Rodic B, Rossier AB. Does sacral posterior rhizotomy suppress autonomic hyper-reflexia in patients with spinal cord injury? Br J Urol 1998; 81(1): 73–82.
38. Barton CH, Khonsari F, Vaziri ND, Byrne C, Gordon S, Friis R. The effect of modified transurethral sphincterotomy on autonomic dysreflexia. J Urol 1986; 135(1): 83–85.
39. ACOG committee opinion. Obstetric management of patients with spinal cord injuries. Number 275, September 2002. Committee on Obstetric Practice. American College of Obstetrics and Gynecology. Int J Gynaecol Obstet 2002; 79(2): 189–191.
40. Eltorai IM, Wong DH, Lacerna M, Comarr AE, Montroy R. Surgical aspects of autonomic dysreflexia. J Spinal Cord Med 1997; 20(3): 361–364.
41. Vaidyanathan S, Soni BM, Sett P, Watt JW, Oo T, Bingley J. Pathophysiology of autonomic dysreflexia: long-term treatment with terazosin in adult and paediatric spinal cord injury patients manifesting recurrent dysreflexic episodes. Spinal Cord 1998; 36(11): 761–770.
42. Lindan R, Leffler EJ, Kedia KR. A comparison of the efficacy of an alpha-I-adrenergic blocker in the slow calcium channel blocker in the control of autonomic dysreflexia. Paraplegia 1985; 23(1): 34–38.
43. McGuire J, Wagner FM, Weiss RM. Treatment of autonomic dysreflexia with phenoxybenzamine. J Urol 1976; 115(1): 53–55.
44. Frankel HL, Mathias CJ. Severe hypertension in patients with high spinal cord lesions undergoing electro-ejaculation – management with prostaglandin E2. Paraplegia 1980; 18(5): 293–299.
45. Kříž J, Rejchrt M. Autonomní dysreflexie – závažná komplikace u pacientů po poranění míchy. Česká a slovenská neurologie a neurochirurgie: časopis českých a slovenských neurologů a neurochirurgů 2014; 77(2): 168–173.
Labels
Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
2014 Issue 4
Most read in this issue
- Extracoporeal shock wave lithotripsy in current urological practice
- Use of multiparametric magnetic resonance imaging and comparison with other modern imaging methods in the preoperative diagnosis of prostate cancer
- Autonomic dysreflexia in patient after spinal cord injury
- Evaluation of erectile dysfunction after robotic assisted radical prostatectomy