Micturition syncope following intermittent catheterisation in a tetraplegic patient.
METHODS
Case report.


OBJECTIVE
To describe a case of severe hypotension and occasional syncope following intermittent catheterisations in a tetraplegic patient.


METHODS
Department of Spinal Injuries, Berck, France.


METHODS
A 47-year-old man presenting with C7 ASIA B tetraplegia for 9 months, developed episodes of severe hypotension and occasional syncope following intermittent catheterisations. These episodes were observed in the minutes following the catheterisations performed in the sitting position, associating hypotension and bradycardia. He was on intermittent catheterisation, had a history of bladder hyper-reflexia with some episodes of symptomatic urinary tract infections, of mild autonomic dysreflexia (headache, sweating) on high bladder distension, of mild orthostatic hypotension, and of reactional depression to the trauma, treated with fluoxetine hydrochloride (Prozac).


RESULTS
The progressive removal of the fluoxetine hydrochloride (Prozac) led to disappearance of the syncope 1 week later. Mild hypotension after catheterisations still persisted though, but completely disappeared a few months later after further management of bladder hyper-reflexia with botulinum-A toxin injections into the detrusor.


CONCLUSIONS
In spinal cord injury patients at risk of micturition syncope, care should be taken to achieve a gradual decrease in bladder volume, to control bladder hyper-reflexia and to avoid any medications with orthostatic hypotension's side effects.
Previnaire
J G
JG
Spinal Unit, Centre Calve, Berck, France.
Soler
J M
JM
D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D006801:Humans; D007024:Hypotension, Orthostatic / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use; D011782:Quadriplegia / Q000150:complications; D013575:Syncope / Q000188:drug therapy / Q000209:etiology*; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000379:methods; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A