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Question 7#

A patient has a spinal cord injury at the level of T4. Which complication can develop?

A. Hypotension associated with nociceptive stimulus below the level of the spinal cord lesion
B. Hypertension associated with nociceptive stimulus below the level of the spinal cord lesion
C. Vasodilatation of the skin below the level of T4 associated with nociceptive stimulus below the level of the spinal cord lesion
D. Sweating below the level of T4 associated with nociceptive stimulus below the level of the spinal cord lesion
E. Profound headache associated with nociceptive stimulus above the level of the spinal cord lesion

Correct Answer is B

Comment:

Answer B

Autonomic dysreflexia is a serious and potentially fatal complication of spinal cord injuries above the level of T6. In patients with a cord lesion above the level of T6 and an intact distal autonomous cord, noxious stimuli (such as urinary tract instrumentation, constipation or blocked catheter) lead to disordered sympathetic response. Vasoconstriction of vascular beds (including splanchnic circulation, skin and skeletal muscle) below the level of the lesion leads to hypertension. To counteract the hypertension, bradycardia may be seen; however due to the level of cord injury the normal physiological response by baroreceptors, including vasodilatation, is prohibited. Above the level of the cord lesion there is flushing and sweating. Systemic features include anxiety and nausea. Management includes preliminary preventative measures, identifying those at risk of autonomic dysreflexia and early recognition. Once it has been identified that this is a urological emergency, the patient should be sat up, triggering factors should be removed and hypertension treated with oral nifedipine, glyceryl trinitrate (GTN) spray, sublingual captopril or administration of intravenous labetalol.