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Autonomic Hyperreflexia: Hemodynamics, Blood Volume, Serum Dopamine-β-Hydroxylase Activity, and Arterial Prostaglandin PGE2

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Spinal Cord Injury

Abstract

The syndrome of autonomic dysreflexia often occurs in quadriplegic subjects and is characterized by paroxysmal hypertension, headache, vasoconstriction below and flushing of the skin above the level of transection, and bradycardia. These attacks may cause hypertensive encephalopathy, cerebral vascular accidents, and death. In five patients during crises, the mean arterial pressure changed from 95 to 154 mmHg, heart rate 72 to 45 beats/min., cardiac output 4.76 to 4.70 litres/min., and peripheral resistance 1650 to 2660 dynes. sec. cm-5. In eight subjects, the control plasma, red cell, and total blood volumes were 19.1, 10.5, and 29.6 ml/cm body height, respectively, and, when hypertensive, the plasma protein concentration increased by 9.9% and the hematocrit by 9.5%. It was estimated that plasma volume was reduced 10–15%. At that time, arterial dopamine-β-hydroxylase (DβH) activity increased 65% and prostaglandin E2 concentration by 68%. Thus, the augmented DβH activity primarily represented elevated sympathetic tone rather than hemoconcentration of that protein. It is also suggested that the rise in prostaglandin may be a contributing cause of the severe headaches during hypertensive episodes.

Reprinted by permission of the American Heart Association from Naftchi, NE, Demeny, M, Lowman, EW, and Tuckman, J. Hypertensive Crises in Quadriplegic Patients. Circulation 57: 336-341, February 1978.

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  1. N. E. Naftchi
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  2. M. Demeny
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  3. M. Berard
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  4. D. Manning
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  5. J. Tuckman
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  1. Institute of Rehabilitation Medicine, New York University Medical Center, N.Y., USA

    N. Eric Naftchi Ph.D.

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Naftchi, N.E., Demeny, M., Berard, M., Manning, D., Tuckman, J. (1982). Autonomic Hyperreflexia: Hemodynamics, Blood Volume, Serum Dopamine-β-Hydroxylase Activity, and Arterial Prostaglandin PGE2 . In: Naftchi, N.E. (eds) Spinal Cord Injury. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-6305-7_12

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