RESUMO
A 44-year-old male person with tetraplegia (C-5 AIS-A (American Spinal Cord Injury Association Standard Neurological Classification of Spinal Cord Injury Impairment Scale)) developed urinary tract infection and received appropriate antibiotic. Subsequently, he started sweating and shivering when he was sitting up; these symptoms resolved while lying on his back. Autonomic dysreflexia triggered by truncal movements continued to occur for 3 months. CT of the spine showed L5-S1 discitis. MRI of the spine showed diffuse marrow oedema in L5 and S1 vertebrae and a large abscess at L5/S1 level. Blood culture yielded Serratia marcescens sensitive to meropenem. Meropenem followed by ertapenem was given for 12 weeks. After 11 months, MRI showed resolution of discitis and epidural collection. The patient was able to sit up for 9 hours without developing autonomic dysreflexia. If a person with cervical spinal cord injury develops posture-related autonomic dysreflexia (eg, in sitting position, lying on sides or while hoisted), disco-vertebral pathology should be suspected.
Assuntos
Antibacterianos/uso terapêutico , Disreflexia Autonômica/diagnóstico , Discite/diagnóstico , Quadriplegia/complicações , Infecções Urinárias/complicações , Adulto , Disreflexia Autonômica/sangue , Disreflexia Autonômica/tratamento farmacológico , Disreflexia Autonômica/microbiologia , Discite/sangue , Discite/tratamento farmacológico , Discite/microbiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Postura , Serratia marcescens/isolamento & purificação , Resultado do Tratamento , Infecções Urinárias/sangue , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologiaAssuntos
Disreflexia Autonômica/etiologia , Sarcoidose/complicações , Doenças da Medula Espinal/complicações , Bexiga Urinaria Neurogênica/etiologia , Adulto , Anti-Inflamatórios/uso terapêutico , Disreflexia Autonômica/sangue , Disreflexia Autonômica/terapia , Feminino , Marcha , Humanos , Imageamento por Ressonância Magnética , Norepinefrina/sangue , Prednisolona/uso terapêutico , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Doenças da Medula Espinal/diagnóstico , Doenças da Medula Espinal/tratamento farmacológico , Tomografia Computadorizada por Raios X , Bexiga Urinaria Neurogênica/sangue , Bexiga Urinaria Neurogênica/terapiaRESUMO
Autonomic dysreflexia (AD) occurs in up to 80% of quadriplegics and high paraplegics and is characterized by exaggerated sympathetic reflexes which induced paroxysmal hypertension. The aim of this study was to determine if plasma catecholamine levels increased during autonomic dysreflexia in the chronic spinal cord-injured (SCI) rats with special care to adrenaline. Catecholamine samples were collected before, during and 1 h after AD induced hypertension with colorectal distension. Results showed that plasma noradrenaline and adrenaline levels increased respectively 1.5-fold and 5-fold during AD in the chronic SCI rats. This suggests substantial roles for these two hormones in mediating the cardiovascular changes during AD. Knowledge of catecholamine levels during AD may thus aid in determining pathophysiology and potential pharmacologic treatments of this autonomic dysfunction.