Autonomic dysreflexia-like syndrome in a T12 paraplegic during thoracic spine surgery.
A 19-year-old African American man with a T12 spinal cord lesion underwent a T4-L5 thoracolumbar spinal fusion. Intraoperatively, his arterial blood pressure acutely increased from 110/60 to 260/130 mm Hg without a change in heart rate. The patient did not have pheochromocytoma, carcinoid syndrome, or thyroid storm. This presentation differs from autonomic dysreflexia because the spinal cord lesion was well below T6, hypertension was elicited with somatic stimulation above the lesion, and the response required aggressive pharmacologic management. This presentation is consistent with similar cases that support a central autonomic process.
Blacker
Samuel N
SN
Department of Anesthesiology, National Naval Medical Center, Bethesda, Maryland, USA. Samuel.Blacker@gmail.com
Brown
Carlton Q
CQ
Tarant
Nicki S
NS
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D020211:Autonomic Dysreflexia / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D001794:Blood Pressure; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D016343:Monitoring, Intraoperative; D010264:Paraplegia / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013577:Syndrome; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome
D000959:Antihypertensive Agents