Finestone H M, Teasell R W
Department of Physical Medicine and Rehabilitation, University Hospital, London, Ontario, Canada.
Am J Phys Med Rehabil. 1993 Dec;72(6):395-7.
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.
自主神经反射异常是一种尚未被充分了解的病症，通常发生在脊髓损伤患者中，表现为阵发性高血压、心动过缓、严重的搏动性头痛、焦虑以及损伤平面以上部位出汗。一名18岁男性接受了第四脑室下部（即最后区）的成血管细胞瘤切除术。术后他出现了自主神经功能衰竭的症状。后来他反复出现腹痛、高血压、皮肤潮红和头痛的阵发性发作。随后发现他患有胃溃疡。对其进行治疗后，症状和体征明显改善。我们推测，手术导致交感神经输出减少，造成了类似于脊髓损伤患者的情况。胃溃疡的有害刺激引发了自主神经反射异常。在其他脑干肿瘤切除病例中，可能会发生未被识别的自主神经反射异常发作。该病例还表明，交感神经的脊髓上控制位于延髓或更高水平。
