Advertisement

Autonomic Hyperreflexia

  • Hyndhavi ChowdaryEmail author
  • Lesley Gilbertson
Chapter

Abstract

Autonomic hyperreflexia is a well-known clinical emergency in individuals who have suffered a spinal cord injury at level T6 or above. Symptoms of autonomic hyperreflexia in patients with complete and incomplete paraplegia above T6 can be caused by almost any stimulus in the abdominal area or in the lower extremities, especially during parturition by uterine contractions. The symptoms vary from sweating and piloerection to serious blood pressure crisis and cerebrovascular accidents. Epidural anesthesia and general anesthesia are effective as therapy and also as prophylaxis. The perception of labor pain is clearly possible with lesions above T10.

Keywords

Pregnancy Spinal cord lesions Autonomic hyperreflexia Prevention Management 

References

  1. 1.
    Mathias CJ, Frankel HL. Cardiovascular control in spinal man. Annu Rev Physiol. 1988;50:577–92.CrossRefGoogle Scholar
  2. 2.
    Teasell RW, Arnold JMO, Krassioukov A, Delaney GA. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury. Arch Phys Med Rehabil. 2000;81(4):506–16.CrossRefGoogle Scholar
  3. 3.
    Mathias CJ, Frankel HL. Autonomic disturbances in spinal cord lesions. In: Mathias CJ, Bannister R, editors. Autonomic failure: a textbook of disorders of the autonomic nervous system; 1999. p. 494–513.Google Scholar
  4. 4.
    Abouleish E. Hypertension in a paraplegic parturient. Anesthesiology. 1980;53(4):348–9.CrossRefGoogle Scholar
  5. 5.
    Guttmann L, Frankel HL, Paeslack V. Cardiac irregularities during labour in paraplegic women. Spinal Cord. 1965;3(2):144–51. Nature Publishing Group.CrossRefGoogle Scholar
  6. 6.
    Frankel HL, Mathias CJ. Cardiovascular aspects of autonomic dysreflexia since Guttmann and Whitteridge (1947). Spinal Cord. 1979;17(1):46–51. Nature Publishing Group.CrossRefGoogle Scholar
  7. 7.
    Robertson DN, Guttmann L. The paraplegic patient in pregnancy and labour. Proc R Soc Med. 1963;56(5):381–7. Royal Society of Medicine Press.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Brown R, Burton A, Macefield VG. Input–output relationships of a somatosympathetic reflex in human spinal injury. Clin Auton Res. 2009;19(4):213–20. D. Steinkopff-Verlag.CrossRefGoogle Scholar
  9. 9.
    Krassioukov A, Warburton DE, Teasell R, Eng JJ. A systematic review of the management of autonomic dysreflexia after spinal cord Injury. Arch Phys Med Rehabil. 2009;90(4):682–95.CrossRefGoogle Scholar
  10. 10.
    Sharpe EE, Arendt KW, Jacob AK, Pasternak JJ. Anesthetic management of parturients with pre-existing paraplegia or tetraplegia: a case series. Int J Obstet Anesth. 2015;24(1):77–84.CrossRefGoogle Scholar
  11. 11.
    Kuczkowski KM. Labor analgesia for the parturient with prior spinal surgery: what does an obstetrician need to know? Arch Gynecol Obstet. 2006;274(6):373–5. Springer.CrossRefGoogle Scholar
  12. 12.
    Castro JS, Lourenço C, Carrilho M. Successful pregnancy in a woman with paraplegia. BMJ Case Rep. 2014;2014:bcr2013202479.Google Scholar
  13. 13.
    Burns R, Clark VA. Epidural anaesthesia for caesarean section in a patient with quadriplegia and autonomic hyperreflexia. Int J Obstet Anesth. 2004;13(2):120–3.CrossRefGoogle Scholar
  14. 14.
    Naftchi NE, Richardson JS. Autonomic dysreflexia: pharmacological management of hypertensive crises in spinal cord injured patients. J Spinal Cord Med. 1997;20(3):355–60.PubMedGoogle Scholar
  15. 15.
    Braddom RL, Rocco JF. Autonomic dysreflexia: a survey of current treatment. Am J Phys Med Rehabil. 1991;70(5):234.CrossRefGoogle Scholar
  16. 16.
    Frost F. Antihypertensive therapy, nifedipine and autonomic dysreflexia. Arch Phys Med Rehabil. 2002;83:1325–6.CrossRefGoogle Scholar
  17. 17.
    Anton HA, Townson A. Drug therapy for autonomic dysreflexia. CMAJ. 2004; 170:1210.CrossRefGoogle Scholar
  18. 18.
    Bertschy, et al. Delivering care under uncertainty: Swiss providers experiences in caring for women with spinal cord injury during pregnancy and childbirth—an expert interview study. BMC Pregnancy Childbirth. 2016;16:181.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.UC Department of AnesthesiologyUniversity of CincinnatiCincinnatiUSA
  2. 2.University of Cincinnati Medical Center and West Chester Hospital, University of CincinnatiCincinnatiUSA

Personalised recommendations