Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Toronto, Ontario, M4G 3V9, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Canada.
Mult Scler Relat Disord. 2018 Jul;23:1-3. doi: 10.1016/j.msard.2018.04.007. Epub 2018 Apr 16.
Cardiovascular autonomic dysfunction is a relatively common secondary complication of tetraplegia. In addition to low baseline arterial blood pressure, tetraplegics can develop sudden-onset hypertensive episodes associated with a variety of symptoms and signs (so-called autonomic dysreflexia). Unfortunately, this potentially life-threatening medical entity is often overlooked and mismanaged. With this, a case of typical presentation of autonomic dysreflexia in an individual with acute severe cervical spinal cord impairment due to neuromyelitis optica (NMO) is reported and discussed.
A 60-year-old, Asian woman developed a rapidly progressive tetraplegia associated with neurogenic bladder and bowel, and cardiovascular autonomic dysfunction due to NMO. In addition to low baseline blood pressure and orthostatic hypotension, the patient developed episodes of autonomic dysreflexia during the acute stage following C2 motor complete tetraplegia. The episodes of autonomic dysreflexia resolved after fecal disimpaction. Her blood pressure stabilized after fecal disimpaction, even though occasional, milder episodes of autonomic dysreflexia occurred during bowel routines in the acute and subacute stages after tetraplegia. Her cardiovascular function normalized as she also regained motor and sensory function in the chronic stage after initial flare of NMO.
This case report illustrates a clinically relevant, but still under-recognized cardiovascular autonomic complication of severe, cervical or high-thoracic spinal cord impairment due to NMO. In addition to low baseline blood pressure and orthostatic hypotension, the patient developed episodes of autonomic dysreflexia during the acute stage after tetraplegia. Autonomic dysreflexia requires early diagnosis and proper treatment in order to prevent severe complications or death. Greater awareness of this potentially life-threatening cardiovascular emergency of spinal cord impairment is needed among patients, caregivers, and healthcare professionals, including neurologists.
心血管自主功能障碍是四肢瘫痪的一种常见继发性并发症。除了基础血压偏低外，四肢瘫痪患者还可能出现突发性高血压发作，伴有各种症状和体征（所谓的自主反射异常）。不幸的是，这种潜在危及生命的医学病症常常被忽视和处理不当。在此，报告并讨论了一例因视神经脊髓炎（NMO）导致急性严重颈髓损伤的患者出现典型自主反射异常的病例。
一名 60 岁亚裔女性因 NMO 发展为迅速进展性四肢瘫痪，伴有神经性膀胱和肠道功能障碍以及心血管自主功能障碍。除了基础血压偏低和直立性低血压外，该患者在 C2 运动完全性四肢瘫痪后的急性期还出现了自主反射异常发作。自主反射异常在粪便排出后得到缓解。尽管在四肢瘫痪后的急性期和亚急性期，排便过程中偶尔会出现较轻的自主反射异常，但粪便排出后其血压得到稳定。随着 NMO 初始发作后的慢性期她恢复了运动和感觉功能，其心血管功能也恢复正常。
本病例报告说明了一种临床相关但仍未被充分认识的心血管自主并发症，其由 NMO 导致的严重颈髓或高胸段脊髓损伤引起。除了基础血压偏低和直立性低血压外，该患者在四肢瘫痪后的急性期还出现了自主反射异常发作。为了预防严重并发症或死亡，自主反射异常需要早期诊断和适当治疗。需要提高患者、护理人员和医疗保健专业人员（包括神经科医生）对这种潜在危及生命的脊髓损伤心血管急症的认识。
