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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Less than 10% of men with complete spinal cord injury experience ejaculation in intercourse. Vibratory stimulation of the penis triggers a predictable series of body reactions in most men with lesions above the thoracic 11th spinal cord level. These reactions are very similar to the physical manifestations of the sexual response in men with intact nervous systems. Between half and three quarters of men with lesions above the thoracic 11th spinal cord level ejaculate. The spermatozoa count is within the normal range, but the percentage of motile spermatozoa is low. The reactions leading to ejaculation take between 30 sec and 3 min and are characterized by rhythmic abdominal and leg spasms, lowered, then elevated pulse rates, elevation of blood pressure, and after the culmination of these experiences, relaxation, tiredness, and a general feeling of well-being. Autonomic dysreflexia (elevation of the blood pressure and severe headache) was avoided with preventive medication. The observations suggest that interrelated ejaculatory centers may be located in the thoracic 11th-and-below areas of the spinal cord. The vibratory stimulation technique has positive implications for both the reproductive and sexual needs of men with spinal cord injury and their partners.
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PMID:Clinical observations in vibratory stimulation of the penis of men with spinal cord injury. 260 39

Autonomic dysreflexia, a syndrome sometimes occurring in spinal cord injured (SCI) individuals, may be life-threatening. It involves, in varying degrees, hypertension, diaphoresis, headache, bradycardia, anxiety, and flushing and is believed due to unrestricted sympathetic activity below the level of the lesion in individuals with injuries above T4-6. The most frequent causes of the syndrome are urinary infections, rectal impaction, bladder distention, and decubitus ulcers. To our knowledge, medication has seldom been described as causal agent. We report here on an autonomic dysreflexic syndrome following use of an isometheptene combination (Midrin), to treat migraine. The individual involved is a C4-quadriplegic man with a long history of migraines. He was given a standard initial adult dose of the medication. Over a one-hour period, he was initially relieved of the headache, but then noted a new more severe headache, diaphoresis, and flushing. His vital signs showed progressive BP elevation to 210/130 and a relative bradycardia. Treatment over the next three hours was limited to elevation of the head of the bed and observation, during which his vital signs returned to baseline and he became asymptomatic. This experience reinforces the belief that sympathomimetic drugs in general, and isometheptene in particular, should be used in caution in patients with high-level SCI.
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PMID:Autonomic dysreflexia due to medication: misadventure in the use of an isometheptene combination to treat migraine. 403 34

Autonomic dysreflexia (AD) is a syndrome that consists of facial flushing, excessive sweating, nasal congestion, throbbing headache and paroxysmal hypertension which may occur in response to bladder distension in patients with spinal cord lesions above the T6 level. We report the case of a C2 quadriplegic patient who developed clinical features of AD along with cortical blindness and seizures after administration of meglumine (Hypaque) for diagnostic cystogram.
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PMID:Seizures and cortical blindness after meglumine (hypaque) administration: a variant of autonomic dysreflexia. 812 Mar 39

Autonomic dysreflexia is a poorly understood entity, typically occurring in the spinal cord-injured patient, with paroxysmal hypertension, bradycardia, severe throbbing headache, anxiety and sweating above the level of the lesion. An 18-year-old man underwent removal of a hemangioblastoma from the inferior portion of the fourth ventricle, a region known as the area postrema. Postoperatively he exhibited signs of autonomic failure. He later developed recurrent paroxysmal episodes of abdominal pain, hypertension, skin flushing and headaches. He subsequently was found to have a gastric ulcer. Symptoms and signs significantly improved with its treatment. We postulate that diminished sympathetic outflow occurred as a result of the surgery, creating a situation similar to the spinal cord-injured patient. Autonomic dysreflexia was elicited as a consequence of the noxious input of the gastric ulcer. In other cases of brainstem tumor resection, unrecognized episodes of autonomic dysreflexia may occur. This case also indicates that sympathetic supraspinal control is located at the level of the medulla or higher.
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PMID:Autonomic dysreflexia after brainstem tumor resection. A case report. 826 Jan 35

Autonomic dysreflexia has long been considered a sympathetically mediated phenomenon. Recent articles have reported the use of alpha blockers as a means of treatment. We report the case of a 20-year-old C5 American Spinal Injury Association A spinal cord injured patient who almost daily experienced symptoms of headache, facial flushing, and hypertension consistent with autonomic dysreflexia. These symptoms caused him frequent discomfort and anxiety. Despite an extensive workup, we were unable to identify a source of his dysreflexic episodes. After starting metoprolol 50 mg every night, however, these episodes stopped and the patient showed no adverse effects from the medication.
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PMID:Beta blockade in the treatment of autonomic dysreflexia: a case report and review. 959 3

Increasing numbers of patients with spinal cord injury present for surgery or obstetric care. Spinal cord injury causes unique pathophysiological changes. The most important peri-operative dangers are autonomic dysreflexia, bradycardia, hypotension, respiratory inadequacy and muscle spasms. Autonomic dysreflexia is suggested by headache, sweating, bradycardia and severe hypertension and may be precipitated by surgery, especially bladder distension. Patients with low, complete lesions, undergoing surgery below the level of injury, may safely do so without anaesthesia provided there is no history of autonomic dysreflexia or troublesome spasms. An anaesthetist should be present to monitor the patient in this situation. General anaesthesia of sufficient depth is effective at controlling spasms and autonomic dysreflexia but hypotension and respiratory dysfunction are risks. There is a growing consensus that spinal anaesthesia is safe, effective and technically simple to perform in this group of patients. We present a survey of 515 consecutive anaesthetics in cord-injured patients and a review of the current literature on anaesthesia for patients with chronic spinal cord lesions.
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PMID:Anaesthesia for chronic spinal cord lesions. 989 63

Autonomic dysreflexia, or hyperreflexia, is a life-threatening condition that can occur in a person with a spinal cord injury at or above the T6 level. The classic signs and symptoms are severe hypertension, pounding headache, and diaphoresis. Prevention is the key to avoiding this disease process. This article reviews the pathophysiology, precipitating factors, signs and symptoms, nursing management, and effects of the problem. All healthcare providers must be aware of this condition in order to prevent permanent impairments in clients who may experience it.
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PMID:Autonomic dysreflexia: a clinical rehabilitation problem. 1020 58

Hypertension, bradycardia, and severe headache have been associated with autonomic dysreflexia. Autonomic dysreflexia affects those with spinal transection above the level of T6 after plastic changes of the afferent pathways. This restructuring in the presence of noxious stimuli below the level of the lesion leads to autonomic dysreflexia. The onset of the first episode of autonomic dysreflexia has been documented as soon as 30 days and as late as 13 years after the injury. This report presents a case study of a paraplegic man 8 years after injury with autonomic dysreflexia associated with a urinary tract infection.
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PMID:Autonomic dysreflexia presenting as a severe headache. 1033 78

Increased intraspinal nerve growth factor (NGF) after spinal cord injury (SCI) is detrimental to the autonomic nervous system. Autonomic dysreflexia is a debilitating condition characterized by episodic hypertension, intense headache, and sweating. Experimentally, it is associated with aberrant primary afferent sprouting in the dorsal horn that is nerve growth factor (NGF)-dependent. Therapeutic strategies that neutralize NGF may ameliorate initial apoptotic cellular responses to the injury and aberrant afferent plasticity that occurs weeks after the injury. Subsequently, the development of autonomic disorders may be suppressed. We constructed a protein including the extracellular portion of trkA fused to the Fc portion of human IgG and expressed it using a baculovirus system. Binding of our trkA-IgG fusion protein was specific for NGF with a K(d) = 4.26 x 10(-11) M and blocked NGF-dependent neuritogenesis in PC-12 cells. We hypothesized that binding of NGF in the injured cord by our trkA-IgG fusion protein would diminish autonomic dysreflexia. Severe, high thoracic SCI was induced with clip compression and the rats were treated with intrathecal infusions (4 microg/day) of trkA-IgG or control IgG. At 14 days post-SCI, the magnitude of autonomic dysreflexia was assessed. Colon distension increased mean arterial pressure (MAP) in control rats by 46 +/- 2 from 96 +/- 5 mmHg. In contrast, MAP of rats treated with trkA-IgG increased by only 30 +/- 2 mmHg. Likewise, the MAP response to cutaneous stimulation was also reduced in rats treated with trkA-IgG (20 +/- 1 vs. 29 +/- 2). In contrast, trkA-IgG treatment had no effect on heart rate responses during colon distension or cutaneous stimulation. These results indicate that treatment with trkA-IgG to block NGF suppresses the development of autonomic dysreflexia after a clinically relevant spinal cord injury.
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PMID:Neutralizing intraspinal nerve growth factor with a trkA-IgG fusion protein blocks the development of autonomic dysreflexia in a clip-compression model of spinal cord injury. 1254 55

Autonomic dysreflexia is a potentially life-threatening hypertensive medical emergency that occurs most often in spinal cord-injured individuals with spinal lesions at or above the mid-thoracic spinal cord level. It is a condition that remains poorly recognised outside of spinal cord injury centres, which may result in adverse outcomes including mortality from potentially delayed diagnosis and treatment. Acute autonomic dysreflexia is characterised by severe paroxysmal hypertension associated with throbbing headaches, profuse sweating, nasal stuffiness, flushing of the skin above the level of the lesion, bradycardia, apprehension and anxiety, which is sometimes accompanied by cognitive impairment. The key to effective management is prevention of the condition, by recognition and avoidance of factors that initiate the condition. When it occurs, immediate recognition and reversal of trigger factors along with prompt administration of pharmacological treatment is of paramount importance in order to prevent complications, which include intracranial and retinal haemorrhage, convulsions, cardiac irregularities and death. Promising data from recent animal studies may hold the key to future treatment options.
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PMID:Recognition and effective management of autonomic dysreflexia in spinal cord injuries. 1747 40


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