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Blood pressure and spinal cord injury

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https://www.readbyqxmd.com/read/29019146/spinal-cord-injury-after-thoracic-endovascular-aortic-aneurysm-repair
#1
Hamdy Awad, Mohamed Ehab Ramadan, Hosam F El Sayed, Daniel A Tolpin, Esmerina Tili, Charles D Collard
PURPOSE: Thoracic endovascular aortic aneurysm repair (TEVAR) has become a mainstay of therapy for aneurysms and other disorders of the thoracic aorta. The purpose of this narrative review article is to summarize the current literature on the risk factors for and pathophysiology of spinal cord injury (SCI) following TEVAR, and to discuss various intraoperative monitoring and treatment strategies. SOURCE: The articles considered in this review were identified through PubMed using the following search terms: thoracic aortic aneurysm, TEVAR, paralysis+TEVAR, risk factors+TEVAR, spinal cord ischemia+TEVAR, neuromonitoring+thoracic aortic aneurysm, spinal drain, cerebrospinal fluid drainage, treatment of spinal cord ischemia...
October 10, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28973505/posterior-reversible-encephalopathic-syndrome-in-the-setting-of-induced-elevated-mean-arterial-pressure-in-patients-with-spinal-cord-injury
#2
Alexander C Whiting, Manuel P Fanarjian, Randall J Hlubek, Jakub Godzik, U Kumar Kakarla, Nicholas Theodore
BACKGROUND AND IMPORTANCE: Acute spinal cord injury (SCI) is managed by avoiding hypotension and elevating mean arterial pressure (MAP) to attain optimal perfusion of the spinal cord. Few studies have been published regarding complications related to this treatment paradigm. CLINICAL PRESENTATION: Three patients with SCI developed posterior reversible encephalopathic syndrome (PRES) during treatment with intravenous fluids and vasopressors administered to maintain elevated MAPs...
July 22, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28967294/an-autonomic-neuroprosthesis-non-invasive-electrical-spinal-cord-stimulation-restores-autonomic-cardiovascular-function-in-individuals-with-spinal-cord-injury
#3
Aaron A Phillips, Jordan W Squair, Dimitry Sayenko, Victor Reggie Edgerton, Yury Gerasimenko, Andrei V Krassioukov
Despite autonomic dysfunction after spinal cord injury being the major cause of death and top health priority, the clinical management options for these conditions are limited to drugs with delayed onset and non-pharmacological interventions with equivocal effectiveness. We tested the capacity of electrical stimulation, applied transcutaneously over the spinal cord, to manage autonomic dysfunction in the form of orthostatic hypotension after spinal cord injury. We assessed beat-by-beat blood pressure (BP), stroke volume and cardiac contractility (dP/dt; Finometer), as well as cerebral blood flow (transcranial Doppler) in five individuals with motor complete spinal cord injury (four cervical, one thoracic) during an orthostatic challenge with and without transcutaneous electrical stimulation applied at the TVII level...
October 1, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28922957/spinal-meninges-and-their-role-in-spinal-cord-injury-a-neuroanatomical-review
#4
Lukas Grassner, Andreas Grillhösl, Christoph Griessenauer, Claudius Thomé, Volker Bühren, Martin Strowitzki, Peter Winkler
Current recommendations support early surgical decompression and blood pressure augmentation after traumatic spinal cord injury (SCI). Elevated intraspinal pressure (ISP), however, has probably been underestimated in the pathophysiology of SCI. Recent studies provide some evidence that ISP measurements and durotomy may be beneficial for individuals suffering from SCI. Compression of the spinal cord against the meninges in SCI patients causes a 'compartment-like' syndrome. In such cases, intentional durotomy with augmentative duroplasty to reduce ISP and improve spinal cord perfusion pressure may be indicated...
September 19, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28921013/spinal-cord-injury-as-a-complication-of-thoracic-endovascular-aneurysm-repair
#5
REVIEW
Taijiro Sueda, Shinya Takahashi
OBJECTIVE: Spinal cord ischemia (SCI) is a devastating complication of thoracic aortic aneurysm repair in the era of thoracic endovascular aneurysm repair (TEVAR). This review aims to clarify the causes of SCI during TEVAR and to propose ways that it may be prevented. METHODS AND RESULTS: We performed an extensive literature search of SCI during TEVAR. Based on the existing literature, we examined the anatomy of the anterior spinal cord artery, which supplies blood to the anterior aspect of the spinal cord, and discuss reported effective ways to prevent SCI during TEVAR, including augmentation of arterial blood pressure and drainage of cerebrospinal fluid...
September 18, 2017: Surgery Today
https://www.readbyqxmd.com/read/28895577/a-study-of-predictors-for-hyponatraemia-in-patients-with-cervical-spinal-cord-injury
#6
P W Song, F L Dong, C C Feng, Y N Shen, Y Wang, R J Zhang, P Ge, C L Shen
STUDY DESIGN: A retrospective study. OBJECTIVES: The objectives of the study were to investigate the predictors for hyponatraemia in patients with cervical spinal cord injuries (CSCIs) and to define the relationship between magnetic resonance imaging (MRI) scans and hyponatraemia. SETTING: The study was carried out at The First Affiliated Hospital of Anhui Medical University. METHODS: A total of 292 patients with CSCIs were retrospectively reviewed to determine the predictors of hyponatraemia...
September 12, 2017: Spinal Cord
https://www.readbyqxmd.com/read/28893706/hypertension-acute-stent-thrombosis-and-paraplegia-6-months-after-tevar-for-blunt-thoracic-aortic-injury-in-a-22-year-old-patient
#7
O Martinelli, F Faccenna, A Malaj, J Jabbour, S Venosi, R Gattuso, B Gossetti, L Irace
TEVAR is a less invasive option for managing traumatic injuries of the descending aorta in polytraumatized patients. Concerns arise when treating young patients with TEVAR. A 22-year old male was admitted to the Emergency Department following a high-impact road traffic collision. Whole body CT scan documented multiple injuries, including rupture of descending thoracic aorta just below the isthmus. There was no evidence of paraplegia or stroke. We decided to treat him in an endovascular fashion with a Zenith Cook (Cook Incorporated, Bloomington, IN) endograft...
September 9, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28844537/baroreflex-autonomic-control-in-human-spinal-cord-injury-physiology-measurement-and-potential-alterations
#8
REVIEW
Adina E Draghici, J Andrew Taylor
The arterial baroreflex is a primary regulator of autonomic outflow to effectively regulate acute changes in blood pressure. After a spinal cord injury (SCI), regulation of autonomic function is disrupted, although the damage of the autonomic pathways may not necessarily be related to the severity of injury (i.e. level and completeness). Nonetheless, it can be assumed that there would be greater loss of sympathetic innervation with higher level of injury and that cardiac parasympathetic control would remain intact regardless of injury level...
August 18, 2017: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/28844181/changes-in-pressure-hemodynamics-and-metabolism-within-the-spinal-cord-during-the-first-7-days-after-injury-using-a-porcine-model
#9
Femke Streijger, Kitty So, Neda Manouchehri, Jae H T Lee, Elena B Okon, Katelyn Shortt, So-Eun Kim, Kurt McInnes, Peter Cripton, Brian K Kwon
Traumatic spinal cord injury (SCI) triggers many perturbations within the injured cord, such as decreased perfusion, reduced tissue oxygenation, increased hydrostatic pressure, and disrupted bioenergetics. While much attention is directed to neuroprotective interventions that might alleviate these early pathophysiologic responses to traumatic injury, the temporo-spatial characteristics of these responses within the injured cord are not well documented. In this study, we utilized our Yucatan mini-pig model of traumatic SCI to characterize intraparenchymal hemodynamic and metabolic changes within the spinal cord for 1 week post-injury...
September 14, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28816870/spinal-cord-injury-what-are-the-controversies
#10
Christopher S Ahuja, Gregory D Schroeder, Alexander R Vaccaro, Michael G Fehlings
Traumatic spinal cord injuries have a tremendous impact on individuals, families, and society as a whole. Substantial heterogeneity in the patient population, their presentation and underlying pathophysiology has sparked debates along the care spectrum from initial assessment to definitive treatment. This article reviews spinal cord injury (SCI) management followed by a discussion of the salient controversies in the field. Current care practices modeled on the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint section guidelines are highlighted including key recommendations regarding immobilization, avoidance of hypotension, early International Standards for Neurological Classification of SCI examination and intensive care unit treatment...
September 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28814247/fluid-and-medication-considerations-in-the-traumatized-patient
#11
Amita Misir
This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Blood products, starting with pRBCs, should be introduced after 20-40 ml/kg of crystalloid has been administered if there is ongoing need for volume replacement. The use of a massive transfusion protocol of 1:1:1 (if >30 kg) or 30:20:20 (if <30 kg) of pRBCs:FFP:platelets is suggested after an initial 30 ml/kg of pRBcs have been administered...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28802811/effects-of-respiratory-training-on-heart-rate-variability-and-baroreflex-sensitivity-in-individuals-with-chronic-spinal-cord-injury
#12
Bonnie E Legg Ditterline, Sevda C Aslan, David C Randall, Susan J Harkema, Camilo Castillo, Alexander V Ovechkin
OBJECTIVE: To evaluate the effects of pressure threshold respiratory training (RT) on heart rate variability and baroreflex sensitivity in persons with chronic spinal cord injury (SCI). DESIGN: Before-after intervention case-controlled clinical study. SETTING: SCI research center and outpatient rehabilitation unit. PARTICIPANTS: Persons with chronic SCI ranging from C2 to T11 that participated in RT (n=24) and untrained chronic SCI controls ranging from C2 to T9 (n=20)...
August 9, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28776131/pure-distraction-injury-of-t1-2-with-quad-fever
#13
Jun-Yeong Seo, Chae-Moon Lim, Young-Hoon Kim, Kee-Yong Ha
INTRODUCTION: We report a pure distraction injury of the upper thoracic spine and uncontrolled hyperthermia without an infectious cause. Quad fever appears in the first several weeks to months after a cervical or upper thoracic SCI and is characterized by an extreme elevation in body core temperature beyond 40 °C without an infectious cause. Discriminating between infectious and noninfectious causes is important, and a thorough clinical assessment is required. MATERIALS AND METHODS: A 52-year-old male visited the emergency room complaining of back pain with complete paralysis [American Spinal Injury Association (ASIA) A] of both lower extremities after a pedestrian-motor vehicle accident...
August 3, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28758566/the-influence-of-level-of-spinal-cord-injury-on-adipose-tissue-and-its-relationship-to-inflammatory-adipokines-and-cardiometabolic-profiles
#14
Gary J Farkas, Ashraf S Gorgey, David R Dolbow, Arthur S Berg, David R Gater
OBJECTIVE: Level of injury (LOI) and the role of adipose tissue and its proinflammatory adipokines in cardiometabolic dysfunction following spinal cord injury (SCI) remains poorly understood. We aim to examine the influence of LOI on adipose tissue and its relationship to proinflammatory adipokines and cardiometabolic profiles following SCI. DESIGN: Cross sectional and correlational study. SETTING: Clinical hospital and academic setting. PARTICIPANTS: Forty-seven individuals with chronic motor complete SCI (age 43...
July 30, 2017: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/28742157/angiotensin-ii-system-in-the-nucleus-tractus-solitarii-contributes-to-autonomic-dysreflexia-in-rats-with-spinal-cord-injury
#15
Kai Wang, Shaoxia Duan, Xueping Wen, Weizhong Wang, Shangping Fang, Dunyi Qi, Xiang Huan, Liwei Wang, Zhenzhou He
BACKGROUND: Autonomic dysreflexia (AD) is a potentially life-threating complication after spinal cord injury (SCI), characterized by episodic hypertension induced by colon or bladder distension. The objective of this study was to determine the role of impaired baroreflex regulation by the nucleus tractus solitarii(NTS) in the occurrence of AD in a rat model. METHODS: T4 spinal cord transection animal model was used in this study, which included 40 Male rats Colorectal distension (CD) was performed to assess AD and compare the changes of BP, HR, and BRS, six weeks after operation...
2017: PloS One
https://www.readbyqxmd.com/read/28728939/autonomic-dysreflexia-somatosympathetic-and-viscerosympathetic-vasoconstrictor-responses-to-innocuous-and-noxious-sensory-stimulation-below-lesion-in-human-spinal-cord-injury
#16
Rachael Brown, Alexander R Burton, Vaughan G Macefield
Autonomic dysreflexia is a dangerous elevation in blood pressure in people with spinal cord injury (SCI), produced by a spinally-mediated reflex activation of sympathetic vasoconstrictor neurones supplying skeletal muscle and the gut. Current dogma states that, apart from visceral inputs - such as those originating from a distended bladder or impacted colon - autonomic dysreflexia is triggered by noxious inputs below the lesion. However, while selective stimulation of small-diameter afferents in muscle or skin evokes a sustained increase in muscle sympathetic nerve activity and blood pressure, and a transient increase in skin sympathetic nerve activity and decrease in skin blood flow in able-bodied subjects, such noxious inputs have no effects on blood pressure and skin blood flow in SCI individuals...
July 13, 2017: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/28699368/impact-of-blood-pressure-lesion-level-and-physical-activity-on-aortic-augmentation-index-in-persons-with-spinal-cord-injury
#17
Caitlyn G Katzelnick, Joseph P Weir, Nancy D Chiaravalloti, Glenn R Wylie, Trevor A Dyson-Hudson, William A Bauman, Jill M Wecht
Individuals with chronic spinal cord injury (SCI) are at a heightened risk of cardiovascular disease (CVD) resulting from autonomic nervous system dysfunction, physical inactivity, and increased inflammatory processes. Arterial stiffness (AS) is recognized as an independent risk factor for CVD and, specifically, pulse wave analysis (PWA) has proven to be a useful tool to predict and track structural arterial changes that reflect arteriosclerosis. The augmentation index (AI) can be used to estimate AS and is derived from the amplitude and timing of the blood pressure (BP) wave reflection in a peripheral artery...
September 21, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28666000/dynamic-wheelchair-seating-positions-impact-cardiovascular-function-after-spinal-cord-injury
#18
Jessica A Inskip, Henrike Rianne J C Ravensbergen, Inderjeet S Sahota, Christine Zawadzki, Lowell T McPhail, Jaimie F Borisoff, Victoria E Claydon
BACKGROUND: Innovative wheelchairs allow individuals to change position easily for comfort and social situations. While these wheelchairs are beneficial in multiple ways, the effects of position changes on blood pressure might exacerbate hypotension and cerebral hypoperfusion, particularly in those with spinal cord injury (SCI) who can have injury to autonomic nerves that regulate cardiovascular control. Conversely, cardiovascular benefits may be obtained with lowered seating. Here we investigate the effect of moderate changes in wheelchair position on orthostatic cardiovascular and cerebrovascular reflex control...
2017: PloS One
https://www.readbyqxmd.com/read/28660164/epidemiology-of-trauma-victims-admitted-to-a-level-2-trauma-center-of-north-india
#19
Vikas Verma, Ajay Singh, Girish Kumar Singh, Santosh Kumar, Vineet Sharma, Ashish Kumar, Vineet Kumar
BACKGROUND: Good quality information on characteristics of victims, types, and frequency of injuries, causes of accidents, vehicles involved in injury and outcome is essential for understanding and planning required for managing the trauma epidemic. The objective of this study was to describe the characteristics of trauma victims admitted to King George's Medical University trauma center. METHODS: This observational study enrolled trauma victims over a 1-year period...
April 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28605971/impaired-baroreflex-function-during-orthostatic-challenge-in-patients-after-spinal-cord-injury
#20
Katarina Ondrusova, Jana Svacinova, Michal Javorka, Jan Novak, Marie Novakova, Zuzana Novakova
The level of spinal cord injury (SCI) affects baroreflex regulation of blood pressure. While a parasympathetic cardiac chronotropic effect is preserved, baroreflex response could be impaired by sympathetic dysfunction under the SCI level. This study was aimed to evaluate the baroreflex function in SCI patients by the analysis of causal interaction between systolic blood pressure (SBP) and inter-beat intervals (IBI). Blood pressure was continuously recorded in 13 cervical SCI patients (CSCI), nine thoracic SCI (ThSCI) and 13 able-bodied controls (Con) during two phases: sitting (PS) and orthostatic challenge (PO)...
August 18, 2017: Journal of Neurotrauma
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