Quantitative analysis of dysautonomia in patients with autonomic dysreflexia
| Autor: | Iñigo Gabilondo, Arrate Orueta, Nora Cívicos Sánchez, Maria Luisa Jáuregui Abrisqueta, Beatriz Tijero, Raquel Suriá Martínez, Nagore Sagastibeltza, Marian Acera, Ane Murueta-Goyena, Rocío Del Pino, Tamara Fernández, Montserrat Cuadrado, Juan Carlos Gómez Esteban |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Blood Pressure Baroreflex 03 medical and health sciences Tilt table test Orthostatic vital signs Hypotension Orthostatic 0302 clinical medicine Heart Rate Internal medicine Heart rate medicine Humans 030212 general & internal medicine Spinal Cord Injuries medicine.diagnostic_test business.industry Dysautonomia medicine.disease Autonomic nervous system Blood pressure Neurology Cardiology Autonomic Dysreflexia Autonomic dysreflexia Female Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Journal of neurology. 268(8) |
| ISSN: | 1432-1459 |
| Popis: | Autonomic dysreflexia (AD) is a life-threatening condition for individuals with cervical or high-thoracic spinal cord injury (SCI). The profile of autonomic dysfunction in AD using validated clinical autonomic tests has not been described so far, although it could be useful to identify SCI patients at greater risk of developing AD non-invasively. With this objective, 37 SCI patients (27% female) were recruited, and hemodynamic and cardiac parameters were continuously monitored to determine the presence of AD, defined as an increase of systolic blood pressure of 20 mmHg or higher after bladder filling with saline. Then, standard autonomic function testing was performed, including Deep Breathing, Valsalva Manoeuvre and Tilt Table Test. Finally, baroreflex sensitivity (BRS), and spectral analysis of heart rate and blood pressure variability were measured at rest. Catecholamines and vasopressin levels were also measured at supine and upright positions. The severity of SCI was assessed through clinical and radiological examinations. AD was observed in 73.3% of SCI patients, being 63.6% of them asymptomatic during the dysreflexive episode. AD patients displayed a drop in sympathetic outflow, as determined by decreased noradrenalin plasma levels, reduced sympathovagal balance and increased BRS. In line with decreased sympathetic activity, the incidence of neurogenic orthostatic hypotension was higher in AD patients. Our results provide novel evidence regarding the autonomic dysfunction in SCI patients with AD compared to non-AD patients, posing non-invasively measured autonomic parameters as a powerful clinical tool to predict AD in SCI patients. |
| Databáze: | OpenAIRE |
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