Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju 501-757, Korea.
Minerva Anestesiol. 2010 Jul;76(7):554-8.
Intracerebral hemorrhage is an unusual complication of autonomic hyperreflexia (AHR), which can be fatal if massive bleeding occurs with subsequent brain herniation. Episodes of AHR are most often triggered by bladder and rectal distention. We present a case of a 45-year-old quadriplegic male who suffered left basal ganglia and thalamic hemorrhage associated with AHR during surgery for pressure sore defects in the prone position under local anesthesia. Early recognition and removal of triggering factors of AHR failed to bring his blood pressure under control. The patient continued to deteriorate neurologically and died 9 days after the attack. A preventive measure rather than episodic treatment of AHR may be of paramount importance to avoid life-threatening complications, especially when a patient with a history of AHR is undergoing surgery in the prone position.
脑出血是自主反射亢进（AHR）的一种罕见并发症，如果发生大量出血伴随后脑疝，可能是致命的。AHR 发作最常由膀胱和直肠扩张引发。我们报告了一例 45 岁四肢瘫痪男性患者的病例，他在局部麻醉下俯卧位手术治疗压疮缺陷时发生左侧基底节和丘脑出血合并 AHR。早期识别和去除 AHR 的触发因素未能控制他的血压。患者神经功能继续恶化，并在发病后 9 天死亡。对于避免危及生命的并发症，预防性措施而不是 AHR 的发作性治疗可能至关重要，尤其是当有 AHR 病史的患者在俯卧位接受手术时。
