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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Autonomic dysreflexia (AD) is a syndrome that often occurs in patients with spinal cord injuries above T-6 and can have life-threatening results if not properly managed. The hypertension associated with AD can cause a great deal of morbidity and mortality, requiring quick and effective blood pressure reduction. Both pharmacologic and nonpharmacologic methods are used to prevent or alleviate the symptoms associated with an acute episode of AD. We found that current literature is lacking in controlled, prospective, randomized studies comparing the efficacy of various medications used in the treatment of AD. We conducted a nationwide survey to determine the consensus among clinicians concerning the management of AD. The survey was designed to determine the current clinical status of AD, to assess methods of treatment being used and to summarize and give a rationale for the drugs most commonly prescribed. Finally, a suggestion for a wallet-sized card briefly outlining effective treatments of AD in an emergency situation is included. Results indicate that most clinicians feel that after nonpharmacologic measures have failed, antihypertensive medication is useful in controlling the symptoms of AD while the inciting cause is being found and treated. Agents used most frequently include, but are not limited to, nifedipine, phenoxybenzamine, prazosin, mecamylamine and nitrates.
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PMID:Autonomic dysreflexia. A survey of current treatment. 191 Jun 47

Autonomic dysreflexia is an emergency condition resulting in sudden severe hypertension that can occur in spinal cord injury (SCI) patients above the T-5-6 level. This hypertension has its proximate cause in neurologic, not cardiovascular, mechanisms. Knowledge about pathophysiology, possible consequences, and signs and symptoms will assist the nurse in identifying this syndrome, locating and removing causes, controlling symptoms, and preventing morbidity or mortality. A case study is used to illustrate a typical autonomic dysreflexia episode in a hospitalized patient at risk. Prevention of autonomic dysreflexia and patient and professional education are also addressed.
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PMID:Autonomic dysreflexia: a nursing challenge in the care of the patient with a spinal cord injury. 205 Nov 83

Autonomic dysreflexia may present itself as a medical emergency in quadriplegics and paraplegics above the T6 level. Common causes are bladder/bowel dysfunction and pressure ulcers. A case study is presented in which an ovarian cyst was the cause of autonomic dysreflexia. Excision of the ovarian cyst stopped recurrence of paroxysmal hypertension and completely alleviated signs and symptoms of autonomic dysreflexia.
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PMID:Ovarian cyst and autonomic dysreflexia. 274 73

Autonomic dysreflexia is a potentially fatal condition occurring in quadriplegics and paraplegics whose spinal cord lesion lies above the greater splanchnic outflow. Prompt recognition of common and less common clinical findings and a search for the causative stimulus are essential. Bladder distention and fecal impaction are the two most likely causes. Should it persist after removal of the stimulus, hypertension requires aggressive drug therapy to control massive sympathetic outflow.
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PMID:Autonomic dysreflexia in the spinal cord-injured. What the physician should know about this medical emergency. 373 1

Autonomic dysreflexia and catecholamine secreting tumor, each of which causes paroxysmal hypertension, coexisted in a young man. Two years after neuroblastoma was diagnosed, he developed T4 incomplete paraplegia due to metastases to the spine at T5 and L3 levels. Shortly after the onset of paraplegia, paroxysmal hypertension developed. The hypertension was controlled adequately by good bowel and bladder management and oral clonidine. The paroxysmal hypertension is believed to have resulted from the synergistic effect of the high levels of circulating catecholamines from the tumor and the disruption of autonomic pathways.
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PMID:Autonomic dysreflexia in a paraplegic man with catecholamine-secreting neuroblastoma. 374 Oct 83

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 clinical phenomenon that affects patients with spinal cord injury (SCI) above the major sympathetic outflow tract. The lesion is most often at or above the T-6 level. Any noxious stimuli below this level initiate reflex sympathetic activity resulting in life threatening hypertension uncontrollable by the feedback parasympathetic activity. The episodes of hypertension generally persist until the offending stimulus is removed. Absence of higher control over reflex sympathetic activity due to transection of the cord is an anatomical explanation of the phenomenon. Current evidence suggests additional factors such as supersensitivity and possibly increased numbers of spinal alpha adrenoreceptors and peripheral microvascular adrenoreceptors as well as accumulation of substance P below the lesion. It has been suggested that substance P acts as a modulator, initiating the sympathetic event to produce a strong, slow and prolonged excitatory action. Autonomic dysreflexia is further accentuated by the absence of gamma amino benzoic acid (GABA), norepinephrine (NE) and 5-hydroxytryptamine (5-HT) below the lesion. GABA is an inhibitory neurotransmitter. It has been suggested that either NE or 5-HT may also act as an inhibitory neurotransmitter. Resetting of the baroreceptors at a lower level also plays an important role. The anatomical transection at or above T-6 then helps in maintaining and accentuating the biochemical changes that develop in patients with high spinal cord lesions. The current article reviews the pathophysiology and management of this potentially life threatening, yet easily treatable, phenomenon.
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PMID:Autonomic dysreflexia revisited. 764 Sep 77

Autonomic dysreflexia manifested as episodic hypertension after spinal cord injury may occur because of changes in sympathetic preganglionic neurons (SPNs) in response to loss of bulbospinal inputs. We studied dysreflexia in rats one week after midthoracic spinal cord hemisection or complete transection. After cord hemisection at the fifth thoracic segment all rats had hemiparaplegia and after complete transection they were paraplegic and exhibited dysreflexia characterized by pressor responses to distension of the urinary bladder. Changes in morphology of SPNs retrogradely labelled by cholera toxin and Fluoro Gold were examined and changes also were assessed in expression of the synaptic vesicular protein synaptophysin. A comparison of SPNs rostral and caudal to the lesion revealed significant dendritic degeneration and decreased soma size after the loss of supraspinal input. Expression of synaptophysin was normally observed rostral to a cord hemisection but this immunoreactivity was increased caudal to the lesion. In conclusion significant structural changes in SPNs occur within a week after cord injury. The abnormal cardiovascular control and exaggerated reflex reactions may be due to new synapse formation on these SPNs.
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PMID:Reflex and morphological changes in spinal preganglionic neurons after cord injury in rats. 773 81

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


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