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Autonomic dysreflexia

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https://www.readbyqxmd.com/read/29923813/muscle-invasive-bladder-cancer-presenting-as-recurrent-autonomic-dysreflexia-a-wolf-in-wolf-s-clothing
#1
Ryan Fitzpatrick, Richard Baverstock
CONTEXT: Autonomic dysreflexia is a potentially lethal condition experienced by spinal cord injury (SCI) patients. It has a wide range of causes, most of which are genitourinary in nature. However, there has been no documented case of primary bladder cancer as a trigger for recurrent autonomic dysreflexia. FINDINGS: We present a case of a 51-year-old spinal cord injury patient with multiple presentations of autonomic dysreflexia. Work up revealed locally invasive bladder cancer, and following definitive surgery, his symptoms were alleviated...
June 20, 2018: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/29802910/the-feasibility-of-blood-flow-restriction-exercise-in-patients-with-incomplete-spinal-cord-injury
#2
Jon Stavres, Tyler J Singer, Amber Brochetti, Martin Kilbane, Steven Brose, John McDaniel
BACKGROUND: Blood flow restriction (BFR) exercise, which already has shown promise in the able-bodied population, may be a novel method for improving muscle function in the incomplete spinal cord injury (iSCI) population. However, the feasibility and tolerance for BFR exercise in this population is unknown. OBJECTIVE: To determine the feasibility and safety of BFR exercise in the iSCI population, with special attention paid to acute hemodynamic changes and the risk of deep vein thrombosis (DVT)...
May 23, 2018: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/29787691/the-influence-of-spinal-cord-injury-on-breastfeeding-ability-and-behavior
#3
Theodor Holmgren, Amanda H X Lee, Shea Hocaloski, Lynsey J Hamilton, Iris Hellsing, Stacy Elliott, Claes Hultling, Andrei V Krassioukov
BACKGROUND: Lactation dysfunction following spinal cord injury has been noted in the literature. However, researchers have often grouped together all women of physical disability or do not account for injury level. The extent of lactation dysfunction and influence of spinal cord injury on breastfeeding ability and behavior is not well understood. Research aim: This study aimed to identify major barriers to lactation and breastfeeding related to spinal cord injury, specifically comparing high- and low-level injuries...
May 1, 2018: Journal of Human Lactation: Official Journal of International Lactation Consultant Association
https://www.readbyqxmd.com/read/29733260/improving-primary-care-for-persons-with-spinal-cord-injury-development-of-a-toolkit-to-guide-care
#4
James Milligan, Joseph Lee, Loretta M Hillier, Karen Slonim, Catharine Craven
OBJECTIVE: To identify a set of essential components for primary care for patients with spinal cord injury (SCI) for inclusion in a point-of-practice toolkit for primary care practitioners (PCP) and identification of the essential elements of SCI care that are required in primary care and those that should be the focus of specialist care. DESIGN: Modified Delphi consensus process; survey methodology. SETTING: Primary care. PARTICIPANTS: Three family physicians, six specialist physicians, and five inter-disciplinary health professionals completed surveys...
May 7, 2018: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/29689472/autonomic-dysreflexia-following-acute-myelitis-due-to-neuromyelitis-optica
#5
Julio C Furlan
BACKGROUND: Cardiovascular autonomic dysfunction is a relatively common secondary complication of tetraplegia. In addition to low baseline arterial blood pressure, tetraplegics can develop sudden-onset hypertensive episodes associated with a variety of symptoms and signs (so-called autonomic dysreflexia). Unfortunately, this potentially life-threatening medical entity is often overlooked and mismanaged. With this, a case of typical presentation of autonomic dysreflexia in an individual with acute severe cervical spinal cord impairment due to neuromyelitis optica (NMO) is reported and discussed...
April 16, 2018: Multiple Sclerosis and related Disorders
https://www.readbyqxmd.com/read/29650001/prediction-of-autonomic-dysreflexia-during-urodynamics-a-prospective-cohort-study
#6
Matthias Walter, Stephanie C Knüpfer, Jacquelyn J Cragg, Lorenz Leitner, Marc P Schneider, Ulrich Mehnert, Andrei V Krassioukov, Martin Schubert, Armin Curt, Thomas M Kessler
BACKGROUND: Autonomic dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to assess neurogenic lower urinary tract dysfunction due to spinal cord injury and reveal crucial pathological findings, such as neurogenic detrusor overactivity. However, neurogenic detrusor overactivity and urodynamic investigation are known to be leading triggers of autonomic dysreflexia...
April 13, 2018: BMC Medicine
https://www.readbyqxmd.com/read/29644100/persistent-urine-leakage-around-a-suprapubic-catheter-the-experience-of-a-person-with-chronic-tetraplegia
#7
Subramanian Vaidyanathan, Jerry Ward, Bakul M Soni, Peter Hughes, Tun Oo
Introduction: Persistent urine leakage after suprapubic cystostomy in tetraplegic subjects occurs due to shrinkage of the urinary bladder and bladder spasms. The patient's social life is adversely affected as clothes become wet, smelly, and require frequent changing, thus increasing the workload of carers. Case presentation: A 48-year-old male sustained C-4 complete (AIS:A) tetraplegia while swimming in 2007. Suprapubic cystostomy was performed in 2009. From 2012, this patient had urine leakage around the suprapubic catheter, which became progressively more frequent...
2018: Spinal Cord Series and Cases
https://www.readbyqxmd.com/read/29610439/soluble-tnf%C3%AE-signaling-within-the-spinal-cord-contributes-to-the-development-of-autonomic-dysreflexia-and-ensuing-vascular-and-immune-dysfunction-after-spinal-cord-injury
#8
Eugene Mironets, Patrick Osei-Owusu, Valerie Bracchi-Ricard, Roman Fischer, Elizabeth A Owens, Jerome Ricard, Di Wu, Tatiana Saltos, Eileen Collyer, Shaoping Hou, John R Bethea, Veronica J Tom
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...
April 25, 2018: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
https://www.readbyqxmd.com/read/29563843/fatal-cerebral-hemorrhage-in-a-tetraplegic-patient-due-to-autonomic-dysreflexia-triggered-by-delay-in-emptying-urinary-bladder-after-unsuccessful-intermittent-catheterization-by-carer-lessons-learned
#9
Subramanian Vaidyanathan, Bakulesh M Soni, Peter L Hughes, Tun Oo
Introduction: Over-distension of urinary bladder in a high spinal cord injury patient is a triggering factor for autonomic dysreflexia. Removing triggering factors is vital to prevent autonomic dysreflexia. Case presentation: A 36-year-old tetraplegic patient, who was managed by intermittent catheterizations performed by caregivers, developed recurrent autonomic dysreflexia during a week due to: 1) carers not performing intermittent catheterizations every night; 2) infrequent catheterizations during the day, leading to distension of urinary bladder...
2018: International Medical Case Reports Journal
https://www.readbyqxmd.com/read/29515212/positive-airway-pressure-therapy-for-sleep-disordered-breathing-confers-short-term-benefits-to-patients-with-spinal-cord-injury-despite-widely-ranging-patterns-of-use
#10
Jeanette P Brown, Kristy A Bauman, Armando Kurili, Gianna M Rodriguez, Anthony E Chiodo, Robert G Sitrin, Helena M Schotland
STUDY DESIGN: Prospective, cohort study. OBJECTIVES: To evaluate the effectiveness of bi-level positive airway pressure (PAP) therapy and the patterns of use for sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI). SETTING: Academic tertiary care center, USA. METHODS: Overall, 91 adults with C1-T6 SCI for ≥3 months were recruited and 74 remained in the study to be evaluated for SDB and follow-up...
March 7, 2018: Spinal Cord
https://www.readbyqxmd.com/read/29485358/the-knowledge-about-autonomic-dysreflexia-among-nursing-and-physiotherapy-students
#11
Nada Strčić, Dean Markić
CONTEXT/OBJECTIVE: Autonomic dysreflexia is a clinical syndrome affecting persons with spinal cord lesions. The aim of the study was to detect the level of knowledge among students about autonomic dysreflexia in persons with spinal cord lesions. DESIGN: Single centre questionnaire study. SETTING: Faculty of Health Studies, Rijeka, Croatia. PARTICIPANTS: Nursing (n = 43) and physiotherapy (n = 48) students. OUTCOME MEASURES: AD knowledge test...
February 27, 2018: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/29424661/preventive-care-among-primary-care-patients-living-with-spinal-cord-injury
#12
Aisha Lofters, Maha Chaudhry, Morgan Slater, Andree Schuler, James Milligan, Joseph Lee, Sara J T Guilcher
OBJECTIVE: Context/Objective: Family physicians may lack the knowledge or resources to adequately support patients with spinal cord injury (SCI). Our objectives were to determine patterns of preventive care for patients with SCI in a primary care setting (i.e. cancer screening, influenza vaccinations, general physicals, bone mineral density tests), and determine physicians' level of comfort with providing primary care to patients with SCI. DESIGN: i) Retrospective chart review, ii) Survey of physicians in the family practice...
February 9, 2018: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/29259348/cold-pressor-test-in-spinal-cord-injury-revisited
#13
REVIEW
Michèle Hubli, Doris Bolt, Andrei V Krassioukov
STUDY DESIGN: Systematic review. OBJECTIVES: A spinal cord injury (SCI) commonly results in alterations of cardiovascular physiology. In order to investigate such alterations, the cold pressor test (CPT) has been used as an established challenge test. This review summarizes the basic physiology underlying a CPT, discusses potential mechanisms responsible for abnormal pressor responses following SCI, and highlights the utility of CPT in the SCI population. SETTING: Canada and Switzerland...
December 20, 2017: Spinal Cord
https://www.readbyqxmd.com/read/29239268/a-community-perspective-on-bowel-management-and-quality-of-life-after-spinal-cord-injury-the-influence-of-autonomic-dysreflexia
#14
Jessica A Inskip, Vera-Ellen M Lucci, Maureen S McGrath, Rhonda Willms, Victoria E Claydon
Autonomic dysfunction is common in individuals with spinal cord injury (SCI) and leads to numerous abnormalities, including profound cardiovascular and bowel dysfunction. In those with high-level lesions, bowel management is a common trigger for autonomic dysreflexia (AD; hypertension provoked by sensory stimuli below the injury level). Improving bowel care is integral for enhancing quality of life (QoL). We aimed to describe the relationships between bowel care, AD, and QoL in individuals with SCI. We performed an online community survey of individuals with SCI...
May 1, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29226126/prevalence-of-autonomic-dysreflexia-in-patients-with-spinal-cord-injury-above-t6
#15
Eun Sun Lee, Min Cheol Joo
Objective: To investigate the prevalence of autonomic dysreflexia (AD) using ambulatory blood pressure monitoring (ABPM) and the autonomic dysfunction following spinal cord injury (ADFSCI) questionnaire in patients with spinal cord injury (SCI) above T6. Methods: Twenty-eight patients diagnosed with SCI above T6 were enrolled. ABPM and ADFSCI were utilized to assess AD. Using ABPM, systolic blood pressure (SBP), diastolic blood pressure, and heart rate (HR) were measured at 30-minute intervals...
2017: BioMed Research International
https://www.readbyqxmd.com/read/29205090/rapamycin-exacerbates-cardiovascular-dysfunction-after-complete-high-thoracic-spinal-cord-injury
#16
Khalid C Eldahan, David H Cox, Jenna L Gollihue, Samir P Patel, Alexander G Rabchevsky
Autonomic dysreflexia (AD) is a potentially life-threatening syndrome in individuals with spinal cord injury (SCI) above the T6 spinal level that is characterized by episodic hypertension in response to noxious stimuli below the lesion. Maladaptive intraspinal plasticity is thought to contribute to the temporal development of AD, and experimental approaches that reduce such plasticity mitigate the severity of AD. The mammalian target of rapamycin (mTOR) has gained interest as a mediator of plasticity, regeneration, and nociceptor hypersensitivity in the injured spinal cord...
March 15, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29160143/some-autonomic-deficits-of-acute-or-chronic-cervical-spinal-contusion-reversed-by-interim-brainstem-stimulation
#17
Alberto A Vitores, Stephanie S Sloley, Catalina Martinez, Melissa M Carballosa-Gautam, Ian D Hentall
Prolonged electrical stimulation of the hindbrain's nucleus raphe magnus (NRM) or of its major midbrain input region, the periaqueductal gray (PAG), was previously found in rats to promote recovery from sensory-motor and histological deficits of acute thoracic spinal cord injury (SCI). Here, some visceral deficits of acute and chronic midline cervical (C5) contusion are similarly examined. Cranially implanted wireless stimulators delivered intermittent 8 Hz, 30-70 μA cathodal pulse trains to a brainstem microelectrode...
February 1, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29141501/transient-hypertension-after-spinal-cord-injury-leads-to-cerebrovascular-endothelial-dysfunction-and-fibrosis
#18
Aaron A Phillips, Nusrat Matin, Mengyao Jia, Jordan W Squair, Aaron Monga, Mei Mu Zi Zheng, Rahul Sachdeva, Andrew Yung, Shea Hocaloski, Stacy Elliott, Piotr Kozlowski, Anne M Dorrance, Ismail Laher, Philip N Ainslie, Andrei V Krassioukov
We aimed to create a clinically relevant pre-clinical model of transient hypertension, and then evaluate the pathophysiological cerebrovascular processes resulting from this novel stimulus, which has recently been epidemiologically linked to cerebrovascular disease. We first developed a clinically relevant model of transient hypertension, secondary to induced autonomic dysreflexia after spinal cord injury and demonstrated that in both patients and rats, this stimulus leads to drastic acute cerebral hyperperfusion...
February 1, 2018: Journal of Neurotrauma
https://www.readbyqxmd.com/read/29138603/fatal-collapse-due-to-autonomic-dysreflexia-during-manual-self-evacuation-of-bowel-in-a-tetraplegic-patient-living-alone-lessons-to-learn
#19
Subramanian Vaidyanathan, Bakul M Soni, Paul Mansour, Tun Oo
Background: To identify areas for improvement, the National Health Service in England mandates the review of case reports of patients who have died, which should be translated into improved care for other patients. Case report: A 49-year-old Caucasian man sustained C-7 tetraplegia in a motorcycle accident in 1992. In 2009, he developed seizures and collapsed in the lavatory on a number of occasions during manual self-evacuation of his bowel. A 24-hour electrocardiogram recording at that time showed sinus rhythm with a maximum heart rate of 97 and a minimum of 39 beats per minute; there were no significant arrhythmias that could have contributed to his episodes of collapse...
2017: International Medical Case Reports Journal
https://www.readbyqxmd.com/read/29089975/autonomic-dysreflexia-a-cardiovascular-disorder-following-spinal-cord-injury
#20
REVIEW
Hisham Sharif, Shaoping Hou
Autonomic dysreflexia (AD) is a serious cardiovascular disorder in patients with spinal cord injury (SCI). The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons (SPNs) caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes...
September 2017: Neural Regeneration Research
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