Autonomic dysreflexia

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Abstract

Autonomous dysreflexia (AD) is a life-threatening condition that occurs in patients with spinal cord injury at the Th6 level and above. As a result of AD, dysregulation of the autonomic nervous system occurs, which leads to an uncoordinated sympathetic reaction, and can result in a potentially life-threatening increase in blood pressure, a hypertensive crisis, and even death. In about 85% of cases of AD, the cause is bladder overdistension. Urologists need to understand the clinical features of this condition and how to help patients with AD.

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About the authors

Grigory G. Krivoborodov

N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Author for correspondence.
Email: Dr.krivoborodov@yandex.ru
ORCID iD: 0000-0001-8347-0531

Ph.D., MD, professor at the Department of Urology and Andrology; Head of the Department of Urology of SD “Russian Gerontological Scientific-Clinical Center”

Russian Federation, 117513, Moscow, Ostrovityanova St., 1

Nikolay S. Yefremov

N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Email: nefr@yandex.ru
ORCID iD: 0000-0002-1536-219X

Ph.D., urologist, associate professor at the Department of Urology and Andrology; urologist at the SD “Russian Gerontological Scientific-Clinical Center”

Russian Federation, 117513, Moscow, Ostrovityanova St., 1

Andrey D. Bolotov

N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Email: adbolotov@gmail.com
ORCID iD: 0000-0002-8142-9495

Ph.D., urologist, Pirogov City Clinical Hospital No.1; assistant at the Department of Urology and Andrology in N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Russian Federation, Moscow

Alina A. Gontar

N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Email: Dr.gontar@yahoo.com
ORCID iD: 0000-0002-7072-4026

urologist, SD “Russian Gerontological Scientific-Clinical Center”

Russian Federation, 129226, Moscow, 1-ya Leonova St., 16

Denis A. Shirin

N.I. Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation

Email: Dok.shirin@mail.com
ORCID iD: 0000-0002-9037-5580

urologist, SD “Russian Gerontological Scientific-Clinical Center”

Russian Federation, Moscow

References

  1. World Health Organization. Spinal cord injury. 2013. https://tinyurl.com/ s2o4ffu (accessed 12 September 2020).
  2. Нейрохирургия. Европейское руководство: в 2 томах. Т. 2. /ред. Х.Б. Лумента и др.; пер. с англ. под ред. Д.А. Гуляева. М.: Издательство Панфилова; БИНОМ. Лаборатория знаний, 2013. 699 с.
  3. Новоселова И.Н. Этиология и клиническая эпидемиология позвоночно-спинномозговой травмы. Литературный обзор. Российский нейрохирургический журнал им. профессора А.Л. Поленова. 2019;11(4): 84–92. EDN MGTZJD.
  4. Vaidyanathan S, Soni B, Oo T, Hughes P, Singh G, Pulya K. Autonomic dysreflexia in a tetraplegic patient due to a blocked urethral catheter: spinal cord injury patients with lesions above T-6 require prompt treatment of an obstructed urinary catheter to prevent life-threatening complications of autonomic dysreflexia. Int J Emerg Med. 2012 Feb 1;5:6. doi: 10.1186/1865-1380-5-6. PMID: 22296914; PMCID: PMC3395851.
  5. Shergill I.S., Arya M., Hamid R., Khastgir J., Patel H.R., Shah P.J. The importance of autonomic dysreflexia to the urologist. BJU Int. 2004 May;93(7):923-6. doi: 10.1111/j.1464-410X.2003.04756.x. PMID: 15142138.
  6. Walter M., Knüpfer S.C., Leitner L., Mehnert U., Schubert M., Curt A., Kessler T.M. Autonomic dysreflexia and repeatability of cardiovascular changes during same session repeat urodynamic investigation in women with spinal cord injury. World J. Urol. 2016 Mar;34(3):391-7. doi: 10.1007/s00345-015-1589-1
  7. Blok, B. F. EAU Guidelines on Neuro-Urology / B. F. Blok, D. Castro-Diaz, G. Del Popolo, J. Groen, R. Hamid, G. Karsenty, T.M. Kessler, J. Pannek. – European Association of Urology : Arnhem, The Netherlands, 2022.
  8. Hilton J. Pain and the therapeutic influence of mechanical and physiological rest in accidents and surgical diseases. Lancet 1860; 2: 401.
  9. Bowlby A.A. The reflexes in cases of injury to the spinal cord. Lancet 1890; 1: 1071.
  10. Henry H. and George Riddoch. The automatic bladder, excessive sweating and some other reflex conditions, in gross injuries of the spinal cord.Brain. 1917 ;40:188-263.
  11. Brooks C.M. Reflex activation of the sympathetic system in the spinal cat. Am. J. Physiol. 1933;106: 251.
  12. Del Fabro A.S., Mejia M., Nemunaitis G. An investigation of the relationship between autonomic dysreflexia and intrathecal baclofen in patients with spinal cord injury. J. Spinal Cord Med. 2018 Jan;41(1):102-105. doi: 10.1080/10790268.2017.1314878
  13. Kurnick N.B. Autonomic hyperreflexia and its control in patients with spinal cord lesions. Ann. Intern. Med. 1956 Apr;44(4):678-86. doi: 10.7326/0003-4819-44-4-678. PMID: 13303038;
  14. Giannantoni A., Di Stasi S.M., Scivoletto G., Mollo A., Silecchia A., Fuoco U., Vespasiani G. Autonomic dysreflexia during urodynamics. Spinal Cord. 1998 Nov;36(11):756-60. doi: 10.1038/sj.sc.3100684. PMID: 9848482
  15. Allen K.J., Leslie S.W. Autonomic Dysreflexia. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482434
  16. Krassioukov A.V., Furlan J.C., Fehlings M.G. Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity. J. Neurotrauma. 2003 Aug;20(8):707-16. doi: 10.1089/089771503767869944. PMID: 12965050
  17. Liu N., Zhou M.W., Biering-Sørensen, F., Krassioukov, A.V., 2016. Cardiovascular response during urodynamics in individuals with spinal cord injury. Spinal Cord http://dx.doi. org/10.1038/sc.2016.110
  18. Karlsson A.K. Autonomic dysreflexia. Spinal Cord. 1999 Jun;37(6):383-91. doi: 10.1038/sj.sc.3100867. PMID: 10432257;
  19. Eldahan K.C., Rabchevsky A.G. Autonomic dysreflexia after spinal cord injury: Systemic pathophysiology and methods of management. Auton. Neurosci. 2018;209:59–70. doi: 10.1016/j.autneu.2017.05.002
  20. Lee E.S., Joo M.C. Prevalence of Autonomic Dysreflexia in Patients with Spinal Cord Injury above T6. Biomed Res. Int. 2017;2017:2027594. doi: 10.1155/2017/2027594. Epub 2017 Oct 26. PMID: 29226126; PMCID: PMC5684522
  21. Dickinson T., Payne C., Drake M.J., Haylen B.T. An International Continence Society (ICS) Report on the Terminology for Adult Neurogenic Lower Urinary Tract Dysfunction (ANLUTD) Neurourol. Urodyn. 2017 Nov 17.
  22. Balik V., Šulla I. Autonomic Dysreflexia following Spinal Cord Injury. Asian J. Neurosurg. 2022 Aug 25;17(2):165-172. doi: 10.1055/s-0042-1751080. PMID: 36120615; PMCID: PMC9473833
  23. Brown R., Burton A.R., Macefield V.G. Autonomic dysreflexia: Somatosympathetic and viscerosympathetic vasoconstrictor responses to innocuous and noxious sensory stimulation below lesion in human spinal cord injury. Auton. Neurosci. 2018;209:71-78. https://doi.org/10.1016/j.autneu.2017.07.003].
  24. Lindan R., Joiner E., Freehafer A.A., Hazel C. Incidence and clinical features of autonomic dysreflexia in patients with spinal cord injury. Paraplegia. 1980 Oct;18(5):285-92. doi: 10.1038/sc.1980.51. PMID: 7443280
  25. Curt A., Nitsche B., Rodic B., Schurch B., Dietz V. Assessment of autonomic dysreflexia in patients with spinal cord injury. J. Neurol Neurosurg Psychiatry. 1997 May;62(5):473-7. doi: 10.1136/jnnp.62.5.473. PMID: 9153603; PMCID: PMC486854;
  26. Linsenmeyer T.A., Campagnolo D.I., Chou I.H. Silent autonomic dysreflexia during voiding in men with spinal cord injuries. J. Urol. 1996 Feb;155(2):519-22. PMID: 8558650
  27. Walter M., Knüpfer SC, Cragg JJ, Leitner L, Schneider MP, Mehnert U, Krassioukov AV, Schubert M, Curt A, Kessler TM. Prediction of autonomic dysreflexia during urodynamics: a prospective cohort study. BMC Med. 2018 Apr 13;16(1):53. doi: 10.1186/s12916-018-1040-8. PMID: 29650001; PMCID: PMC5898013
  28. Lakra C., Swayne O., Christofi G., Desai M. Autonomic dysreflexia in spinal cord injury. Pract. Neurol. 2021 Dec;21(6):532-538. doi: 10.1136/practneurol-2021-002956. Epub 2021 Aug 5. PMID: 34353860
  29. McGregor J.A., Meeuwsen J. Autonomic hyperreflexia: a mortal danger for spinal cord-damaged women in labor. Am. J. Obstet. Gynecol. 1985 Feb 1;151(3):330-3. doi: 10.1016/0002-9378(85)90297-2. PMID: 3970101
  30. Allen K.J., Leslie S.W. Autonomic Dysreflexia. [Updated 2023 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482434
  31. Courtois F.J., Charvier K.F., Leriche A., Vézina J.G., Côté M., Bélanger M. Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury. BJU Int. 2008 Feb;101(3):331-7. doi: 10.1111/j.1464-410X.2007.07254.x. Epub 2007 Oct 8. PMID: 17922856
  32. Elliott S., Krassioukov A. Malignant autonomic dysreflexia in spinal cord injured men. Spinal Cord. 2006 Jun;44(6):386-92. doi: 10.1038/sj.sc.3101847. Epub 2005 Sep 27. PMID: 16186856
  33. Parke S.C., Reyes M.R. Autonomic Dysreflexia as a Potential Adverse Effect of Duloxetine and Amitriptyline Combination Therapy: A Case Report. PM R. 2019 Feb;11(2):214-218. doi: 10.1016/j.pmrj.2018.07.010. Epub 2019 Feb 8. PMID: 30036681
  34. Kewalramani L.S. Autonomic dysreflexia in traumatic myelopathy. Am. J. Phys. Med. 1980 Feb;59(1):1-21. PMID: 6986791
  35. Partida E., Mironets E., Hou S., Tom V.J. Cardiovascular dysfunction following spinal cord injury. Neural. Regen. Res. 2016 Feb;11(2):189-94. doi: 10.4103/1673-5374.177707. PMID: 27073353; PMCID: PMC4810964
  36. Altaweel W., Corcos J. Pathophysiology of autonomic dysreflexia. In: Corcos J, Schick E, editors. Textbook of the Neurogenic Bladder. London, UK: Martin Dunitz, Taylor and Francis Group; 2004
  37. Duvall J.R., Mathew P.G., Robertson C.E. Headache Attributed to Autonomic Dysreflexia: Clinical Presentation, Pathophysiology, and Treatment. Curr. Pain Headache Rep. 2019 Aug 27;23(11):80. doi: 10.1007/s11916-019-0818-5. PMID: 31456068
  38. Wan D., Krassioukov A.V. Life-threatening outcomes associated with autonomic dysreflexia: a clinical review. J Spinal Cord Med. 2014 Jan;37(1):2-10. doi: 10.1179/2045772313Y.0000000098. Epub 2013 Nov 26. PMID: 24090418; PMCID: PMC4066548
  39. Khanna K., Theologis A.A., Tay B. Autonomic dysreflexia caused by cervical stenosis. Spinal Cord Ser Cases. 2017 Dec 29;3:17102. doi: 10.1038/s41394-017-0018-7. PMID: 29423305; PMCID: PMC5798920
  40. West C.R., Squair J.W., McCracken L., Currie K.D., Somvanshi R., Yuen V., Phillips A.A., Kumar U., McNeill J.H., Krassioukov A.V. Cardiac Consequences of Autonomic Dysreflexia in Spinal Cord Injury. Hypertension. 2016 Nov;68(5):1281-1289. doi: 10.1161/HYPERTENSIONAHA.116.07919. Epub 2016 Oct 3. PMID: 27698067
  41. Sachdeva R., Gao F., Chan C.C.H., Krassioukov A.V. Cognitive function after spinal cord injury: A systematic review. Neurology. 2018 Sep 25;91(13):611-621. doi: 10.1212/WNL.0000000000006244. Epub 2018 Aug 29. PMID: 30158159; PMCID: PMC6161545
  42. Brommer B., Engel O., Kopp M.A., Watzlawick R., Müller S., Prüss H., Chen Y., DeVivo M.J., Finkenstaedt F.W., Dirnagl U., Liebscher T., Meisel A., Schwab J.M. Spinal cord injury-induced immune deficiency syndrome enhances infection susceptibility dependent on lesion level. Brain. 2016 Mar;139(Pt 3):692-707. doi: 10.1093/brain/awv375. Epub 2016 Jan 10. PMID: 26754788; PMCID: PMC5014125
  43. Zhang Y., Guan Z., Reader B., Shawler T., Mandrekar-Colucci S., Huang K., Weil Z., Bratasz A., Wells J., Powell N.D., Sheridan J.F., Whitacre C.C., Rabchevsky A.G., Nash M.S., Popovich P.G. Autonomic dysreflexia causes chronic immune suppression after spinal cord injury. J. Neurosci. 2013 Aug 7;33(32):12970-81. doi: 10.1523/JNEUROSCI.1974-13.2013. PMID: 23926252; PMCID: PMC3735880
  44. Khastgir J., Drake M.J., Abrams P. Recognition and effective management of autonomic dysreflexia in spinal cord injuries. Expert Opin. Pharmacother. 2007 May;8(7):945-56. doi: 10.1517/14656566.8.7.945. PMID: 17472540
  45. Rabchevsky A.G., Kitzman P.H. Latest approaches for the treatment of spasticity and autonomic dysreflexia in chronic spinal cord injury. Neurotherapeutics. 2011 Apr;8(2):274-82. doi: 10.1007/s13311-011-0025-5. PMID: 21384222; PMCID: PMC3101828
  46. Essat Z. Management of autonomic dysreflexia. Nurs Stand. 2003 Apr 23-29;17(32):42-4. doi: 10.7748/ns.17.32.42.s61. PMID: 12739226
  47. Jackson C.R., Acland R. Knowledge of autonomic dysreflexia in the emergency department. Emerg. Med J. 2011 Oct;28(10):866-9. doi: 10.1136/emj.2009.085159. Epub 2010 Oct 14. PMID: 20947918
  48. Cowan H. Autonomic dysreflexia in spinal cord injury. Nurs Times. 2015 Oct 28-Nov 3;111(44):22-4. PMID: 26665385
  49. Caruso D., Gater D., Harnish C. Prevention of recurrent autonomic dysreflexia: a survey of current practice. Clin. Auton. Res. 2015 Oct;25(5):293-300. doi: 10.1007/s10286-015-0303-0. Epub 2015 Aug 18. PMID: 26280219
  50. Solinsky R., Linsenmeyer T.A. Intravesical lidocaine decreases autonomic dysreflexia when administered prior to catheter change. J. Spinal Cord Med. 2018 Sep 10;42(5):1-5. doi: 10.1080/10790268.2018.1518764. Epub ahead of print. PMID: 30199342; PMCID: PMC6758603
  51. Blackmer J. Rehabilitation medicine: 1. Autonomic dysreflexia. CMAJ. 2003 Oct 28;169(9):931-5. PMID: 14581313; PMCID: PMC219629
  52. Eldahan K.C., Rabchevsky A.G. Autonomic dysreflexia after spinal cord injury: Systemic pathophysiology and methods of management. Auton Neurosci. 2018 Jan;209:59-70. doi: 10.1016/j.autneu.2017.05.002. Epub 2017 May 8. PMID: 28506502; PMCID: PMC5677594
  53. Ramakrishnan Kumaran. (2014). Treatment of Autonomic Dysreflexia for Adults & Adolescents with Spinal Cord Injuries. 10.13140/RG.2.1.2474.9524
  54. Viera A.J. Hypertension Update: Resistant Hypertension. FP Essent. 2018 Jun;469:20-25. PMID: 29863319
  55. Arcangeli A., D’Alò C., Gaspari R. Dexmedetomidine use in general anaesthesia. Curr. Drug Targets. 2009 Aug;10(8):687-95. doi: 10.2174/138945009788982423. PMID: 19702517
  56. Nasr I.A., Elnaghy K.M. Control of autonomic dysreflexia in patients with high level of chronic spinal cord injury during cystoscopy. Ain-Shams J. Anaesthesiol. 2016;9:606–611
  57. Abrams P., Amarenco G., Bakke A., Buczyński A., Castro-Diaz D., Harrison S., Kramer G., Marsik R., Prajsner A., Stöhrer M., Van Kerrebroeck P., Wyndaele J.J.; European Tamsulosin Neurogenic Lower Urinary Tract Dysfunction Study Group. Tamsulosin: efficacy and safety in patients with neurogenic lower urinary tract dysfunction due to suprasacral spinal cord injury. J. Urol. 2003 Oct;170(4 Pt 1):1242-51. doi: 10.1097/01.ju.0000084623.65480.f8. PMID: 14501734
  58. Phillips A.A., Elliott S.L., Zheng M.M., Krassioukov A.V. Selective alpha adrenergic antagonist reduces severity of transient hypertension during sexual stimulation after spinal cord injury. J. Neurotrauma. 2015 Mar 15;32(6):392-6. doi: 10.1089/neu.2014.3590. Epub 2014 Dec 5. PMID: 25093677
  59. Vaidyanathan S., Soni B., Selmi F., Singh G., Esanu C., Hughes P., Oo T., Pulya K. Are urological procedures in tetraplegic patients safely performed without anesthesia? a report of three cases. Patient Saf. Surg. 2012 Feb 20;6:3. doi: 10.1186/1754-9493-6-3. PMID: 22348226; PMCID: PMC3296613
  60. Baraka A., Noueihid R., Sibai A.N., Baroody M., Louis F., Hemady K. Epidural meperidine for control of autonomic hyperreflexia in a quadriplegic undergoing cystoscopy. Middle East J. Anaesthesiol. 1989 Jun;10(2):185-8. PMID: 2811779
  61. Sachdeva R., Nightingale T.E., Pawar K., Kalimullina T., Mesa A., Marwaha A., Williams A.M.M., Lam T., Krassioukov A.V. Noninvasive Neuroprosthesis Promotes Cardiovascular Recovery After Spinal Cord Injury. Neurotherapeutics. 2021 Apr;18(2):1244-1256. doi: 10.1007/s13311-021-01034-5. Epub 2021 Mar 31. PMID: 33791969; PMCID: PMC8423970
  62. Li G.P., Wang X.Y., Zhang Y. Efficacy and Safety of OnabotulinumtoxinA in Patients With Neurogenic Detrusor Overactivity Caused by Spinal Cord Injury: A Systematic Review and Meta-analysis. Int. Neurourol J. 2018 Dec;22(4):275-286. doi: 10.5213/inj.1836118.059. Epub 2018 Dec 31. PMID: 30599499; PMCID: PMC6312972
  63. Jung I.Y., Mo K.I., Leigh J.H. Effect of intravesical botulinum toxin injection on symptoms of autonomic dysreflexia in a patient with chronic spinal cord injury: a case report. J. Spinal Cord Med. 2019 Nov;42(6):806-809. doi: 10.1080/10790268.2017.1322738. Epub 2017 May 9. PMID: 28486884; PMCID: PMC6830299
  64. Walter M., Ramirez A.L., Lee A.H.X., Nightingale T.E., Rapoport D., Kavanagh A., Krassioukov A.V. Fesoterodine Ameliorates Autonomic Dysreflexia While Improving Lower Urinary Tract Function and Urinary Incontinence-Related Quality of Life in Individuals With Spinal Cord Injury: A Prospective Phase IIa Study. J Neurotrauma. 2023 May;40(9-10):1020-1025. doi: 10.1089/neu.2022.0333. Epub 2022 Oct 25. PMID: 36178342.
  65. Salyukov R.V., Kamalov A.A., Okhobotov D.A., Chalyi M.E., Frolova M.V. Efficacy of fesoterodine for prevention of autonomic dysreflexia in patients with neurogenic dysfunction of the bladder after spinal cord injury. Urologiia. 2023;3:47–51. DOI: https://dx.doi.org/10.18565/urology.2023.3.47-51. Russian (Салюков Р.В., Камалов А.А., Охоботов Д.А., Чалый М.Е., Фролова М.В. Применение фезотеродина для профилактики автономной дисрефлексии у пациентов с нейрогенной детрузорной гиперактивностью, возникшей после травмы спинного мозга. Урология. 2023;3:47–51. DOI: https://dx.doi.org/10.18565/urology.2023.3.47-51).
  66. Schurch B., Stöhrer M., Kramer G., Schmid D.M., Gaul G., Hauri D. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J. Urol. 2000 Sep;164(3 Pt 1):692-7. doi: 10.1097/00005392-200009010-00018. PMID: 10953127
  67. Fougere R.J., Currie K.D., Nigro M.K., Stothers L., Rapoport D., Krassioukov A.V. Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury. J. Neurotrauma. 2016 Sep 15;33(18):1651-7. doi: 10.1089/neu.2015.4278. Epub 2016 Apr 13. PMID: 26980078; PMCID: PMC5035837

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