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Hyperreflexia associated with spasticity is a prevalent neurological condition characterized by excessive and exaggerated reflex responses to stimuli. Hyperreflexia can be caused by several diseases including multiple sclerosis, stroke and spinal cord injury (SCI). Although we have previously identified the contribution of the RAC1‐PAK1 pathway underlying spinal hyperreflexia with SCI‐induced spasticity, a feasible druggable target has not been validated. To assess the utility of targeting PAK1 to attenuate H‐reflex hyperexcitability, we administered Romidepsin, a clinically available PAK1 inhibitor, in Thy1‐YFP reporter mice. We performed longitudinal EMG studies with a study design that allowed us to assess pathological H‐reflex changes and drug intervention effects over time, before and after contusive SCI. As expected, our results show a significant loss of rate‐dependent depression – an indication of hyperreflexia and spasticity – 1 month following SCI as compared with baseline, uninjured controls (or before injury). Romidepsin treatment reduced signs of hyperreflexia in comparison with control cohorts and in pre‐ and post‐drug intervention in SCI animals. Neuroanatomical study further confirmed drug response, as romidepsin treatment also reduced the presence of SCI‐induced dendritic spine dysgenesis on α‐motor neurons. Taken together, our findings extend previous work demonstrating the utility of targeting PAK1 activity in SCI‐induced spasticity and support the novel use of romidepsin as an effective tool for managing spasticity. Key points: PAK1 plays a role in contributing to the development of spinal cord injury (SCI)‐induced spasticity by contributing to dendritic spine dysgenesis.In this study, we explored the preclinical utility of inhibiting PAK1 to reduce spasticity and dendritic spine dysgenesis in an SCI mouse model.Romidepsin is a PAK1 inhibitor approved in the US in 2009 for the treatment of cutaneous T‐cell lymphoma.Here we show that romidepsin treatment after SCI reduced SCI‐induced H‐reflex hyperexcitability and abnormal α‐motor neuron spine morphology.This study provides compelling evidence that romidepsin may be a promising therapeutic approach for attenuating SCI‐induced spasticity. [ABSTRACT FROM AUTHOR]

Hemodynamic instability and cardiovascular (CV) dysfunction are hallmarks of patients living with cervical and high thoracic spinal cord injuries (SCI). Individuals experience bouts of autonomic dysreflexia (AD) and persistent hypotension which hamper the activities of daily living. Despite the widespread use of exercise training to improve health and CV function after SCI, little is known about how different training modalities impact hemodynamic stability and severity of AD in a model of incomplete SCI. In this study, we used implantable telemetry devices to assess animals with T2 contusions following 3.5 weeks of exercise training initiated 8 days post‐injury: passive hindlimb cycling (T2‐CYC, n = 5) or active forelimb swimming (T2‐SW, n = 6). Uninjured and non‐exercised SCI control groups were also included (CON, n = 6; T2‐CON, n = 7; T10‐CON, n = 6). Five weeks post‐injury, both T2‐CON and T2‐CYC presented with resting hypotension compared to uninjured CON and T10‐CON groups; no differences were noted in resting blood pressure in T2‐SW versus CON and T10‐CON. Furthermore, pressor responses to colorectal distention (AD) were larger in all T2‐injured groups compared to T10‐CON, and were not attenuated by either form of exercise training. Interestingly, when T2‐injured animals were re‐stratified based on terminal BBB scores (regardless of training group), animals with limited hindlimb recovery (T2‐LOW, n = 7) had more severe AD responses. Our results suggest that the spontaneous recovery of locomotor and autonomic function after severe but incomplete T2 SCI also influences the severity of AD, and that short periods (3.5 weeks) of passive hindlimb cycling or active forelimb swimming are ineffective in this model. [ABSTRACT FROM AUTHOR]

The authors first isolated the stellate ganglia (SG) from wild-type mice, and recorded excitatory postsynaptic currents (EPSCs) following orthograde electrical stimulation of the second thoracic nerve trunk. This protocol permitted Clyburn and colleagues to evoke EPSCs in the SG without activating presumed postganglionic interneurons within the ganglia. Keywords: autonomic dysreflexia; collateral projections; haemodynamics; spinal cord injury; sympathetic nervous system EN autonomic dysreflexia collateral projections haemodynamics spinal cord injury sympathetic nervous system 3443 3444 2 08/17/23 20230815 NES 230815 Sympathetic ganglia have been canonically understood as a simple monosynaptic serial connection between cholinergic preganglionic neurons and noradrenergic postganglionic neurons that innervate peripheral organs, vasculature and the heart. [Extracted from the article]

Aims: To obtain objective evidence for the time to onset of action for intravesical lidocaine utilizing exaggerated sympathetic blood‐pressure responsiveness in patients with spinal cord injuries (SCI). Methods: This prospective observational cohort study analyzed blood pressure responses in individuals with SCI at or above T6 who did (lidocaine‐instillation group) or did not (control group) receive 10 ml of 2% lidocaine gel instilled through their catheters before routine suprapubic catheter change. Care was taken to minimize any potentially confounding position change or catheter manipulation. Given the potential for C‐fiber mediated systolic blood pressure (SBP) increases after SCI, the time to lidocaine's onset of action for blocking these C‐fibers (as seen by the decrease in SBP more than and equal to 10 mm Hg) was assessed with serial blood pressures for 4 to 6 minutes. Results: Blood pressures were evaluated in 32 individuals with SCI (lidocaine‐instillation group n = 22, control group n = 10). In the lidocaine‐instillation group, 45% individuals demonstrated a sustained decrease in SBP more than and equal to 10 mm Hg, which occurred at a mean of 98.1 seconds (SD 59 seconds) after lidocaine instillation. Despite up to 6 minutes of serial monitoring, the remainder of the lidocaine‐instillation group and the entire control group had SBP fluctuations less than 10 mm Hg. The serial mean SBPs of those who responded to lidocaine were significantly less than the remaining groups (P <.001 for both comparisons). Conclusion: Utilizing lidocaine's properties to decrease sympathetic‐inducing afferents after SCI, the time to onset of action for intravesical lidocaine was found to be approximately 90 seconds. This relatively rapid initial onset on action is especially pertinent when managing autonomic dysreflexia. [ABSTRACT FROM AUTHOR]

Individuals with spinal cord injury (SCI) have altered neurophysiology and present with symptoms that must be interpreted in the context of their specific neurologic injury. This is a case of a 16-year-old female adolescent with C5 American Spinal Injury Association Impairment Scale A SCI who presented with intractable nausea. Multiple etiologies for her nausea, including medication effect, metabolic and gastrointestinal disorders, autonomic dysreflexia, and mood disorder, were systematically ruled out. Due to the persistence of the patient's symptoms and suboptimal progression in her rehabilitation, a central nervous system etiology was investigated. Ultimately, atlantoaxial instability with odontoid compression on the medulla was identified and her refractory nausea resolved following an occiput to C2 fusion. To our knowledge, this is the first reported case of atlantoaxial instability causing intractable nausea due to brain stem compression in a patient with SCI. Level of Evidence: V. [ABSTRACT FROM AUTHOR]

Aims Mitochondrial disease (MD) is a genetic disorder affecting skeletal muscles, with possible myocardial disease. The ergoreflex, sensitive to skeletal muscle work, regulates ventilatory and autonomic responses to exercise. We hypothesized the presence of an increased ergoreflex sensitivity in MD patients, its association with abnormal ventilatory and autonomic responses, and possibly with subclinical cardiac involvement. Methods and results Twenty-five MD patients (aged 46 ± 3 years, 32% male) with skeletal myopathy but without known cardiac disease, underwent a thorough evaluation including BNPs, galectin-3, soluble suppression of tumorigenesis 2 (sST2), high sensitivity troponin T/I, catecholamines, ECG, 24-h ECG recording, cardiopulmonary exercise testing, echocardiography, cardiac/muscle magnetic resonance (C/MMR), and ergoreflex assessment. Thirteen age- and sex-matched healthy controls were chosen. Among these myopathic patients, subclinical cardiac damage was detected in up to 80%, with 44% showing fibrosis at CMR. Ergoreflex sensitivity was markedly higher in patients than in controls (64% vs. 37%, P < 0.001), and correlated with muscle fat to water ratio and extracellular volume at MMR (both P < 0.05). Among patients, ergoreflex sensitivity was higher in those with cardiac involvement (P = 0.034). Patients showed a lower peak oxygen consumption (VO2/kg) than controls (P < 0.001), as well as ventilatory inefficiency (P = 0.024). Ergoreflex sensitivity correlated with reduced workload and peak VO2/kg (both P < 0.001), and several indicators of autonomic imbalance (P < 0.05). Plasma norepinephrine was the unique predictor of myocardial fibrosis at univariate analysis (P < 0.05). Conclusions Skeletal myopathy in MD is characterized by enhanced ergoreflex sensitivity, which is associated with a higher incidence of cardiac involvement, exercise intolerance, and sympathetic activation. [ABSTRACT FROM AUTHOR]

Objective. To investigate the prevalence of autonomic dysreflexia (AD) using ambulatory blood pressure monitoring (ABPM) and the autonomic dysfunction following spinal cord injury (ADFSCI) questionnaire in patients with spinal cord injury (SCI) above T6. Methods. Twenty-eight patients diagnosed with SCI above T6 were enrolled. ABPM and ADFSCI were utilized to assess AD. Using ABPM, systolic blood pressure (SBP), diastolic blood pressure, and heart rate (HR) were measured at 30-minute intervals. AD was defined as SBP 20 mmHg higher than basal SBP, and the number of AD events was counted. The ADFSCI questionnaire evaluates the severity and frequency of the AD symptoms. Results. According to the ABPM, AD occurred in 26 patients and AD events occurred 5.8±4.7 times. Average daytime and nighttime SBP were 119.9±18.8 mmHg and 123.8±21.2 mmHg, respectively, and the nighttime mean SBP appeared to be 4 mmHg higher than daytime mean SBP. These findings suggest the loss of nocturnal BP dipping in SCI patients. ADFSCI results revealed that 16 of the patients evaluated were symptomatic while 12 were asymptomatic. Conclusion. AD following SCI above T6 was highly prevalent and several patients seemed asymptomatic. These results suggest the necessity of proper diagnostic and therapeutic interventions for managing AD. [ABSTRACT FROM AUTHOR]

New Findings What is the central question of this study? How does early versus delayed initiation of passive hindlimb cycling, as well as detraining, affect cardiac function and blood pressure control in a rodent model of spinal cord injury?, What is the main finding and its importance? Early or delayed initiation of hindlimb cycling improves cardiac and haemodynamic function in spinal cord injury, although the benefits of early administration are more pronounced. We also demonstrate the need for exercise to be maintained, because detraining rapidly reverses the cardiac and haemodynamic benefits., Spinal cord injury (SCI) reduces physical activity and alters descending supraspinal cardiovascular control, predisposing this population to early onset of cardiovascular disease. We used a T3 SCI rodent model to investigate the effect of early versus delayed passive hindlimb cycling (PHLC), as well as the effect of detraining on cardiac dysfunction and blood pressure control, including autonomic dysreflexia (AD). Twenty male Wistar rats were divided into an early PHLC initiation group followed by a period of detraining (PHLC starting day 6 post-SCI, for 4 weeks, followed by 4 weeks of detraining; 'early PHLC/detraining' group) and a delayed PHLC intervention group (no PHLC for first 5 weeks post-SCI, followed by PHLC for 4 weeks; 'no PHLC/delayed PHLC' group). At 5 weeks post-SCI, the no PHLC/delayed PHLC group exhibited a decline in almost all cardiac indices (all P < 0.029), which was maintained in the early PHLC/detraining group. Also, the severity of induced AD was reduced in the early PHLC/detraining versus no PHLC/delayed PHLC group (all P < 0.0279). At 9 weeks post-SCI, no PHLC/delayed PHLC animals exhibited a reversal of cardiac dysfunction such that all indices were not different from pre-SCI, whereas early PHLC/detraining rats exhibited a reduction in all cardiac indices relative to pre-SCI (all P < 0.049), except ejection fraction. Between weeks 7 and 9 post-SCI, the no PHLC/delayed PHLC rats exhibited fewer spontaneous AD events than the early PHLC/detraining rats ( P < 0.01). We show, for the first time, that delayed exercise promotes similar improvements in cardiac and haemodynamic function to those observed with early initiation. Furthermore, exercise needs to be maintained, because detraining reduces these cardiohaemodynamic benefits. [ABSTRACT FROM AUTHOR]

Aims The risk factors for developing autonomic dysreflexia (AD) during urodynamic (UD) examination in patients with spinal cord injury (SCI) above Th6 still remain unclear. The main goal of our study is to investigate the risk factors that could be associated with AD in these particular patients. Design Cross sectional survey. Subject and methods The study was carried out in 83 patients with SCI above Th6 who were submitted to our center for a UD examination. AD was defined as a rise in systolic blood pressure above 15 mm Hg with a pulse rate below 60 beats per minute. Results The prevalence rate of AD among our patients was 54%. Univariate analysis of our study showed the following risk factors: patient's age, SCI completeness, traumatic etiology, indwelling catheter, presence of chills or sweating, anticholinergic treatment, maximum detrusor voiding pressure, detrusor pressure at maximum flow rate, detrusor external sphincter dyssynergia, and bladder outlet obstruction. Using multivariate logistic regression, we found that there are only two independent risk factors: patient's age equal to or above 45 years of age (OR = 10.995) and maximum detrusor voiding pressure equal to or above 31 cm H2O (OR = 3.879). Conclusions According to our results, the patient's age and maximum detrusor voiding pressure should be considered at the time of performing a UD examination in order to prevent the sudden onset of AD in patients with SCI above Th6. Neurourol. Urodynam. 36:171-175, 2017. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Introduction. We present a novel case of persistent autonomic dysreflexia in a pediatric spinal cord injury patient treated successfully with intravesical botulinum toxin. Study Design. A retrospective chart review of one patient seen at the Children’s Hospital of Wisconsin from 2006 to 2012 was performed. Results. A pediatric spinal cord injury patient with known neurogenic bladder presented with severe hypertension consistent with autonomic dysreflexia. His symptoms and hypertension did not improve with conservative measures, and he necessitated ICU admission and antihypertensive drips. He was taken to the operating room for intravesical botulinum toxin for refractory bladder spasms. Following this, his symptoms abated, and he was weaned off IV antihypertensives and returned to his baseline state. His symptoms were improved for greater than six months. Conclusions. There are few treatment options for the management of refractory autonomic dysreflexia. Intravesical botulinum toxin has never been reported for this use. Dedicated research is warranted to assess its efficacy, as it was used successfully to abort autonomic dysreflexia in this patient. [ABSTRACT FROM AUTHOR]

The study aims to investigate the influence of different postures on spasticity results by pendulum test in patients with spinal cord injury ( SCI). The setting was at the University of Campinas ( UNICAMP), Campinas, SP, Brazil. Five individuals with SCI and five individuals in the control group were included. All individuals went through the pendulum test in three different positions: supine, semi-supine at an angle of 30°, and sitting up at an angle of 60°. An electrogoniometer was attached to the right leg for measurement of knee joint angles. All situations were performed five times. Blood pressure was monitored during tests. Relaxation index ( RI), normalized relaxation index ( RIn), test duration in seconds, initial flexion angle, and resting angle were analyzed at three different positions. Results were compared between different positions, and statistically no differences were found. In individuals with SCI, RI (1.83 ± 0.2), RIn (1.14 ± 0.13), and test duration values (13.95 ± 4.14), in sitting up position, were similar to the control group results. In sitting up position, patients showed spasticity reduction. However, the other two postures produce pain and increase blood pressure in patients with tetraplegia. Therefore, these postures should be avoided in patients with lesions above T6, due to possible autonomic dysreflexia symptoms. [ABSTRACT FROM AUTHOR]

Key content Pregnancy exacerbates most problems associated with spinal cord injury ( SCI)., Diagnosis of labour in women with spinal cord injury above T10 of the spinal cord can be challenging., Women with SCI should aim for a vaginal delivery., Autonomic dysreflexia is life threatening and requires immediate treatment., Early epidural analgesia in labour will reduce the incidence of autonomic dysreflexia., Learning objectives Antenatal management of women with SCI., Care of a woman in labour., Diagnosis and treatment of autonomic dysreflexia., Ethical issues Women with chronic SCI are knowledgeable about the management of their disability, at times more than the attending medical personnel. Not listening to them may undermine the confidence they have in their care., Women with SCI are concerned that a spinal or epidural analgesia may cause further injury to their spinal cord. [ABSTRACT FROM AUTHOR]

Detecting unexpected environmental change causes modulation of autonomic activity essential for survival. Understanding the neural mechanisms associated with responses to loud sounds may provide insights into the pathophysiology of posttraumatic stress disorder ( PTSD), since individuals with PTSD exhibit heightened autonomic responses to unexpected loud sounds. We combined fMRI with autonomic psychophysiological assessment to investigate central and peripheral reactivity to loud tones in 20 healthy participants. Activity in anterior insula, pregenual anterior cingulate cortex, anterior midcingulate cortex, supplementary motor area, supramarginal gyrus, and cerebellar lobules VIII- IX was associated with both tones and concomitant skin conductance responses. Since regions signaling unexpected external events modulate autonomic activity, heightened loud tone autonomic responses in PTSD may reflect sensitization of this 'salience' network. [ABSTRACT FROM AUTHOR]

Pressure ulcers and autonomic dysreflexia (AD) are common complications that may affect individuals with spinal cord injury (SCI). Negative-pressure wound therapy (NPWT) is a frequently used modality to aid in wound healing in the treatment of pressures ulcers in patients with SCI. Although the common triggers of AD have been well described in the literature, there have been no formal reports of NPWT itself as a cause of AD. We detail 2 cases of patients with SCI and with AD thought to be secondary to NPWT and discuss modifications made to allow for continued treatment with NPWT while minimizing further episodes of AD. We propose that NPWT should be considered as a potential source of AD in patients with SCI undergoing this therapy. [ABSTRACT FROM AUTHOR]

Objective - A spinal cord injury (SCI) above the sixth thoracic vertebra interrupts the supraspinal control of the sympathetic nervous system causing an imbalance between the sympathetic and theparasympathetic nervous system. This article focuses on the symptoms, treatment and examination of autonomic disturbances of the cardiovascular and the urinary system after a SCI. Methods - A nonsystematic literature search in the PubMed database. Results - Frequent complications in the acute phase of cervical and high thoracic SCI are bradyarrhythmias, hypotension, hypothermia/hyperthermia, increased neurogenic shock, vagovagal reflex, supraventricular/ventricular ectopic beats, vasodilatation and congestion. Serious complications in the chronic phase of SCI are orthostatic hypotension, impaired cardiovascular reflexes, autonomicdysreflexia (AD), reduced sensation of cardiac pain, loss of reflex cardiac acceleration, quadriplegic cardiac atrophy due to loss of left ventricular mass and pseudo-myocardial infarction. AD is associated with a sudden, uncontrolled sympathetic response, triggered by stimuli below the injury. It may cause mild symptoms like skin rash or slight headache, but also severe hypertension, cerebral haemorrhage and death. Early recognition and prompt treatment are important. Urinaryautonomic dysfunctions include hyperreflexia or areflexia of detrusor and/or sphincter of the bladder. Conclusions - Patients with SCI have a high risk of cardiovascular complications, AD and urinaryautonomic dysfunction both in the acute phase and later, affecting their prognosis and quality of life. Knowledge of cardiovascular and urological complications after SCI is important for proper diagnosisand treatment. [ABSTRACT FROM AUTHOR]

When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1) Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5-10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2) Spinal cord injury patients are at increased risk for getting urine infections as compared to ablebodied individuals. Therefore, antibiotics should be given to patients who get haematuria or urethral bleeding following urethral catheterisation over a guide wire. (3) Some spinal cord injury patients may have a small capacity bladder; in these patients, the guide wire, which is introduced into the urinary bladder, may fold upon itself with the tip of guide wire entering the urethra. If this complication is not recognised and a catheter is inserted over the guide wire, the Foley catheter will then be misplaced in urethra despite using cystoscopy and guide wire. [ABSTRACT FROM AUTHOR]

Loss of consciousness (LOC) in long QT syndrome (LQTS) patients can be caused by torsade de pointes (TdP) or vasovagal syncope (VVS). On genetic testing and head-up tilt testing (HUTT), we diagnosed three young patients with both genotyped LQTS and autonomic dysregulation. According to grade of prolongation of QT interval and LOC status, syncope episodes in two patients were classified as due to VVS, while those of the other patient were due to TdP. We also diagnosed one patient with postural orthostatic tachycardia syndrome. Syncope in LQTS patients should not automatically be labeled TdP. If there is a possibility of VVS, HUTT should be performed, but careful observation is required because TdP cannot be completely ruled out. [ABSTRACT FROM AUTHOR]

Objective: Pregnancy in tetraplegia is a rare event, with only sporadic cases reported. This case series describes seven pregnancies in five tetraplegic women, all with spinal cord injuries in the region of C6. Design: Retrospective case series. Setting: Sydney, Australia. Population: All tetraplegic women presenting to the obstetric service of a university teaching hospital, which also provides a regional spinal injury service, between 1981 and 2006. Methods: Hospital records of all patients were examined and information extracted regarding demographics, pregnancies and their complications, labour and delivery and neonatal data. Main outcome measures: Course, complications, management and outcomes of pregnancy in tetraplegic women. Results: Mean age at the time of injury was 22 years, and, at the time of pregnancy, 33 years. All patients suffered recurrent, and sometimes severe, urinary tract infections and episodes of autonomic dysreflexia during pregnancy. Frequent and sometimes lengthy hospital admissions were required for these and other reasons. Only two pregnancies required caesarean section and all entered labour spontaneously, at a mean of 37.9 weeks of gestation. Episodes of autonomic dysreflexia were aggressively managed using pre-emptive epidural anaesthesia and sublingual nifedipine. All pregnancies resulted in normal, near-term babies with no serious perinatal problems. Conclusions: Pregnancy and childbirth in tetraplegic women can be undertaken safely, usually with spontaneous onset of labour and vaginal delivery. However, hospitalisation for intercurrent problems is common. Management requires a multidisciplinary approach and is best undertaken in major centres with both obstetric and spinal cord injuries medical expertise. [ABSTRACT FROM AUTHOR]

Associate Editor Michael G. Wyllie Editorial Board Ian Eardley, UK Jean Fourcroy, USA Sidney Glina, Brazil Julia Heiman, USA Chris McMahon, Australia Bob Millar, UK Alvaro Morales, Canada Michael Perelman, USA Marcel Waldinger, Netherlands OBJECTIVES To explore the effectiveness of various sources of self-stimulation, including oral midodrine, in triggering ejaculation in men with spinal cord injury (SCI), and to document the systematic variations in blood pressure at ejaculation and consider a revised definition of autonomic dysreflexia. PATIENTS AND METHODS The study included 62 men with SCI lesions from C2 to L2. Ejaculation potential was assessed with various sources of stimulation, beginning with natural stimulation, followed, if the test was negative, by penile vibrator stimulation (PVS) followed, if the test was again negative, by PVS combined with oral midodrine, started at 5 mg and increased in 5 mg steps up to 25 mg. The success rate of ejaculation was recorded, as were blood pressure (BP) changes measured at baseline and at ejaculation (or on the last trial if the test was negative). Reported sensations were also recorded and compared during positive and negative tests. RESULTS Overall, 89% of the patients reached ejaculation with one mode or another of stimulation. When patients had a negative result with natural stimulation, 56% were salvaged by PVS, and when PVS was negative, another 22% were salvaged by midodrine combined with PVS. The mean systolic BP increased by 35 mmHg at ejaculation during PVS and by 11 mmHg after midodrine, and a subsequent 29 mmHg at ejaculation during PVS combined with midodrine. By contrast, negative tests showed a relatively stable BP; the difference in changes in BP during positive and negative tests was significant ( P < 0.01). Increases in BP during positive tests declined significantly more often within the limits of autonomic dysreflexia than negative tests ( P < 0.01). CONCLUSION These results support the view that most men with SCI can obtain an ejaculation when a wide spectrum of stimulation is used, including natural stimulation, PVS, and PVS combined with oral midodrine. Positive tests were associated with significant increases in BP, in contrast to negative tests, where BP was relatively stable. This suggests that significant changes in BP are required for ejaculation and that insignificant changes are predictive of future failure. As most changes in BP during positive tests also fall within the criterion of autonomic dysreflexia, a revised definition of autonomic dysreflexia should be considered to encourage safe experiences with ejaculation and safe use of midodrine. [ABSTRACT FROM AUTHOR]

Non‐plegic post‐traumatic syringomyelia patients can develop autonomic dysreflexia triggered by breastfeeding. [ABSTRACT FROM AUTHOR]

OBJECTIVES To determine whether capsaicin-sensitive nerves in the bladder form the afferent limb involved in autonomic dysreflexia (AD) in patients with spinal cord injury (SCI). PATIENTS AND METHODS Seven men with SCI (five cervical cord, two thoracic cord) with AD and detrusor hyper-reflexia (DH) were enrolled. Under general anaesthesia, capsaicin solution (100 mL of 2 mmol/L in 10% ethanol) was instilled in the bladder and retained for 30 min. The patients were assessed by medium-fill cystometry (CMG) just before and 50 min after the capsaicin treatment. Intra-arterial blood pressure (BP) and heart rate were monitored continuously throughout the procedure; 10% ethanol was instilled before capsaicin treatment in four patients as a control. Serum catecholamines were measured during bladder filling and capsaicin treatment, and the blood ethanol concentration also measured after instillation in all patients. The CMG with concomitant monitoring of BP and heart rate was repeated 1 week, 1, 3, 6, 12 and 24 months after instillation. In two patients the instillations were repeated 5 and 12 months after the first because of recurrence of DH. Urodynamic variables assessed were maximum cystometric capacity (MCC), maximum amplitude of uninhibited detrusor contraction (UICmax), the bladder capacity at 40 cmH2 O detrusor pressure (Cdp40 ) and a systolic BP of> 140 mmHg or diastolic BP of> 90 mmHg (CHT ). RESULTS There was an increase in BP and a decrease in heart rate in all patients during bladder filling before capsaicin treatment. Instillation of capsaicin produced a significant increase in both systolic and diastolic BP and a significant decrease in heart rate. The maximum cardiovascular effects were at 5–10 min after instillation and gradually returned to baseline within 40 min. The vehicle had negligible effects on either BP or heart rate. After capsaicin treatment, the responses of BP and heart rate to bladder distension were significantly reduced. Both serum catecholamine values and the blood ethanol concentration remained within normal limits. The mean (range) follow-up after the first treatment was 15 (6–30) months. One month after treatment all seven patients became continent and their episodes of AD became negligible and well tolerable between catheterizations (for 3–4 h); the effects lasted for ≥ 3 months in all. MCC was significantly increased at 4 weeks and 3 months, and UICmax significantly decreased at 4 weeks after treatment. Both mean Cdp40 and CHT increased 1 week, 1 and 3 months after treatment. Two patients received a second instillation, and have been continent with no symptomatic AD for 6 and 24 months. The remaining five patients have been continent with no symptomatic AD for 6–12 months. CONCLUSION These results indicate that intravesical capsaicin, but not the vehicle, acutely triggers AD in patients with SCI, suggesting involvement of bladder capsaicin- sensitive afferents in AD in these patients. The results also suggest that intravesical capsaicin may be a promising therapy for both AD and DH in such patients. Further long-term follow-up studies are needed to evaluate the duration of its effect. [ABSTRACT FROM AUTHOR]

Effective rehabilitation and modern reproductive technology may increase the number of women considering pregnancy who have spinal cord injuries (SCIs). It is important that obstetricians caring for these patients are aware of the specific problems related to SCIs. Autonomic dysreflexia is the most significant medical complication seen in women with SCIs,and precautions should be taken to avoid stimuli that can lead to this potentially fatal syndrome. Women with SCIs may give birth vaginally, but when cesarean delivery is indicated adequate anesthesia (spinal or epidural if possible) is needed. [ABSTRACT FROM AUTHOR]

Autonomic dysreflexia is a serious complication of high level spinal cord injury. Here, the authors present a case of autonomic dysreflexia in a patient with non‐traumatic spinal cord pathology and review the incidence of such potentially fatal complications in other neurological conditions involving the high level spinal cord. [ABSTRACT FROM AUTHOR]

Spinal lesions can cause intermittent claudication. A 67-year-old man was referred to our department with a 3-year history of progressive intermittent claudication. Spinal magnetic resonance imaging showed only moderate cervical canal stenosis, but not severe lumbar canal stenosis, which could cause intermittent claudication. The gait loading test reproduced tightness and weakness in the lower extremities, as well as an induced pyramidal tract sign that included Achilles tendon hyperreflexia and right ankle clonus. He was therefore diagnosed with spinal intermittent claudication. Two weeks later, sudden lower limb paralysis with urinary retention appeared without a traumatic event. After cervical spine surgery, the intermittent claudication disappeared. Spinal claudication is rare, and a relatively unknown symptom. As such, it is therefore a diagnostic challenge. Here, we highlight the importance of a full clinical report and the usefulness of the gait loading test for determining the clinical diagnosis. [ABSTRACT FROM AUTHOR]