TY - JOUR

T1 - Alarming blood pressure changes during routine bladder emptying in a woman with cervical spinal cord injury

AU - Lee, Amanda H X

AU - Phillips, Aaron A

AU - Squair, Jordan W

AU - Barak, Otto F

AU - Coombs, Geoff B

AU - Ainslie, Philip N

AU - Sarafis, Zoe K

AU - Mijacika, Tanja

AU - Vucina, Diana

AU - Dujic, Zeljko

AU - Krassioukov, Andrei V

PY - 2017/12/28

Y1 - 2017/12/28

N2 - INTRODUCTION: Many individuals with high-level spinal cord injury (SCI) experience secondary conditions such as autonomic dysreflexia (AD), which is a potentially life-threatening condition comprising transient episodes of hypertension up to 300 mmHg. AD may be accompanied by symptoms and signs such as headache, flushing, and sweating. Delay in AD recognition and management is associated with increased incidence of cardiovascular events and disease. As it is commonly triggered by bladder distension, AD continues to be a major concern for individuals living with SCI, both on a daily basis and in the long-term.CASE PRESENTATION: A 58-year-old woman with C3 AIS B SCI presented with low resting blood pressure (BP) at 100/64 mmHg. She reported frequent episodes of AD that were most commonly attributed to urinary bladder filling. During our testing session, her systolic BP rose to 130 mmHg, at which point her care aide stepped in to utilize the Credé maneuver, which was part of her daily routine for bladder emptying. Application of suprapubic pressure further elevated her systolic BP to 230 mmHg. Throughout the episode of AD, the participant experienced a pounding headache and erythema above the LOI.DISCUSSION: Clinical guidelines for bladder management after SCI recommend avoiding the Credé maneuver due to potential complications such as hernia or bruising. This current case report demonstrates the additional risk of inducing AD and dangerously high BP elevation.

AB - INTRODUCTION: Many individuals with high-level spinal cord injury (SCI) experience secondary conditions such as autonomic dysreflexia (AD), which is a potentially life-threatening condition comprising transient episodes of hypertension up to 300 mmHg. AD may be accompanied by symptoms and signs such as headache, flushing, and sweating. Delay in AD recognition and management is associated with increased incidence of cardiovascular events and disease. As it is commonly triggered by bladder distension, AD continues to be a major concern for individuals living with SCI, both on a daily basis and in the long-term.CASE PRESENTATION: A 58-year-old woman with C3 AIS B SCI presented with low resting blood pressure (BP) at 100/64 mmHg. She reported frequent episodes of AD that were most commonly attributed to urinary bladder filling. During our testing session, her systolic BP rose to 130 mmHg, at which point her care aide stepped in to utilize the Credé maneuver, which was part of her daily routine for bladder emptying. Application of suprapubic pressure further elevated her systolic BP to 230 mmHg. Throughout the episode of AD, the participant experienced a pounding headache and erythema above the LOI.DISCUSSION: Clinical guidelines for bladder management after SCI recommend avoiding the Credé maneuver due to potential complications such as hernia or bruising. This current case report demonstrates the additional risk of inducing AD and dangerously high BP elevation.

U2 - 10.1038/s41394-017-0022-y

DO - 10.1038/s41394-017-0022-y

M3 - Article

C2 - 29423304

VL - 3

JO - Spinal cord series and cases

JF - Spinal cord series and cases

SN - 2058-6124

M1 - 17101

ER -