Charcot arthropathy in relation to autonomic dysreflexia in spinal cord injury: case report and review of the literature.
Charcot spinal arthropathy has been described as a late complication of spinal cord injury. In patients with these injuries in whom the spine below the level of injury is insensate, joint trauma can progress until spinal instability ensues. The authors describe the case of a 50-year-old man with complete C-8 tetraplegia who experienced a 4-month history of episodic severe headaches, profuse sweating over his face and arms, and episodic severe hypertension in addition to a "grinding" sensation in the lower back. Charcot arthropathy at the T11-12 levels with pathological mobility was demonstrated on neuroimaging. Intraoperatively, a complete spinal cord transection was identified. Anterior and posterior thoracolumbar fusion across the mobile segment resulted in complete amelioration of signs and symptoms of autonomic dysreflexia. This entity, a common condition in the setting of spinal cord injury, has many triggers. Definitive treatment is targeted at the removal of the underlying cause. As demonstrated here, Charcot spinal arthropathy can act as a powerful trigger for induction of autonomic dysreflexia. Treatment of the associated spinal instability resulted in eradication of all signs and symptoms of the dysreflexia.
Mohit
A Alex
AA
Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington 98104-2499, USA. abmohit@u.washington.edu
Mirza
Sohail
S
James
Jennifer
J
Goodkin
Robert
R
D001177:Arthropathy, Neurogenic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D020211:Autonomic Dysreflexia / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006261:Headache / Q000209:etiology; D006801:Humans; D006945:Hyperhidrosis / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000175:diagnosis / Q000209:etiology; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed