J Korean Neurosurg Soc.  2014 May;55(5):277-279. 10.3340/jkns.2014.55.5.277.

Acute Onset of Intracerebral Hemorrhage due to Autonomic Dysreflexia

• Eker A
• Yigitoglu
• Ipekdal HI
• Tosun A

• KMID: 2018034
• DOI: http://doi.org/10.3340/jkns.2014.55.5.277

Abstract

Autonomic dysreflexia is a clinical emergency syndrome of uncontrolled sympathetic output that can occur in patients who have a history of spinal cord injury. Despite its frequency in spinal cord injury patients, central nervous system complications are very rare. We report a man with traumatic high level incomplete spinal cord injury who suffered hypertensive right thalamic hemorrhage secondary to an episode of autonomic dysreflexia. Prompt recognition and removal of the triggering factor, the suprapubic catheter obstruction which led to hypertensive attack, the patient had a favorable functional outcome after the resorption of the hematoma and effective rehabilitation programme.

Keyword

Spinal cord injury; Intracerebral hemorrhage; Autonomic dysreflexia; Urinary tract obstruction

MeSH Terms

Autonomic Dysreflexia*
Catheter Obstruction
Central Nervous System
Cerebral Hemorrhage*
Emergencies
Hematoma
Hemorrhage
Humans
Rehabilitation
Spinal Cord Injuries

Figure

• 

  Fig. 1 Cervical MRI demonstrates the atrophy of the spinal cord below the level of the trauma.

• 

  Fig. 2 Cranial CT scan demonstrates hemorrhage in the right thalamic nucleus and also in the third, fourth and lateral ventricles.

Reference

1. Blackmer J. Rehabilitation medicine : 1. Autonomic dysreflexia. CMAJ. 2003; 169:931–935. PMID: 14581313.

2. Bycroft J, Shergill IS, Chung EA, Arya N, Shah PJ. Autonomic dysreflexia : a medical emergency. Postgrad Med J. 2005; 81:232–235. PMID: 15811886.

3. Chaves CJ, Lee G. Reversible posterior leukoencephalopathy in a patient with autonomic dysreflexia : a case report. Spinal Cord. 2008; 46:760–761. PMID: 18427565.

4. Colachis SC, Fugate LP. Autonomic dysreflexia associated with transient aphasia. Spinal Cord. 2002; 40:142–144. PMID: 11859441.

5. Dincer U. Autonomic dysfunction and their treatment in spinal cord injury. Turk J Phys Med Rehab. 2010; 56(Suppl 2):93–98.

6. Dolinak D, Balraj E. Autonomic dysreflexia and sudden death in people with traumatic spinal cord injury. Am J Forensic Med Pathol. 2007; 28:95–98. PMID: 17525555.

7. Edvardsson B, Persson S. Reversible cerebral vasoconstriction syndrome associated with autonomic dysreflexia. J Headache Pain. 2010; 11:277–280. PMID: 20186562.

8. Eltorai I, Kim R, Vulpe M, Kasravi H, Ho W. Fatal cerebral hemorrhage due to autonomic dysreflexia in a tetraplegic patient : case report and review. Paraplegia. 1992; 30:355–360. PMID: 1598177.

9. Furusawa K, Tokuhiro A, Sugiyama H, Ikeda A, Tajima F, Genda E, et al. Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury. Spinal Cord. 2011; 49:49–54. PMID: 20697419.

10. Pan SL, Wang YH, Lin HL, Chang CW, Wu TY, Hsieh ET. Intracerebral hemorrhage secondary to autonomic dysreflexia in a young person with incomplete C8 tetraplegia : a case report. Arch Phys Med Rehabil. 2005; 86:591–593. PMID: 15759250.

11. Park KS, Lee YW. Cardiovascular response to experimental spinal cord trauma in cats. J Korean Neurosurg Soc. 1981; 10:419–426.

12. Vallès M, Benito J, Portell E, Vidal J. Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient. Spinal Cord. 2005; 43:738–740. PMID: 16010281.

13. Vallès-Casanova M, Benito-Penalva J, Portell-Soldevila E, Vidal-Samsó J. [Cerebral hemorrhage secondary to autonomic dysreflexia in a spinal cord injury]. Med Clin (Barc). 2006; 127:358. PMID: 16987460.

14. Weaver LC, Marsh DR, Gris D, Brown A, Dekaban GA. Autonomic dysreflexia after spinal cord injury : central mechanisms and strategies for prevention. Prog Brain Res. 2006; 152:245–263. PMID: 16198705.

15. Yamashita T, Hiramatsu H, Sakai N, Namba H. Cerebral hemorrhage due to posterior reversible encephalopathy syndrome associated with autonomic dysreflexia in a spinal cord injury patient. Neurol Med Chir (Tokyo). 2012; 52:640–643. PMID: 23006876.

16. Yokomizo Y, Goubara A, Tanaka K, Yokoyama O. [A case of cerebellar hemorrhage secondary to autonomic dysreflexia (AD) in a patient with cervical spinal cord injury]. Hinyokika Kiyo. 2010; 56:659–661. PMID: 21187714.

17. Yoo KY, Jeong CW, Kim WM, Lee HK, Kim SJ, Jeong ST, et al. Fatal cerebral hemorrhage associated with autonomic hyperreflexia during surgery in the prone position in a quadriplegic patient : a case report. Minerva Anestesiol. 2010; 76:554–558. PMID: 20613698.