What are the effects of autonomic dysfunction following spinal cord infarction?

From the Guidelines

Autonomic dysfunction following spinal cord infarction can lead to significant morbidity and mortality, and its management should prioritize reducing symptoms and supporting overall autonomic regulation. The effects of autonomic dysfunction following spinal cord infarction can be far-reaching, impacting various bodily systems.

Key Considerations

• Orthostatic hypotension, neurogenic bladder, bowel dysfunction, temperature dysregulation, and sexual dysfunction are common complications that require tailored management approaches.
• Non-pharmacological interventions, such as compression stockings, abdominal binders, and gradual position changes, can be effective for orthostatic hypotension.
• Medications like midodrine (2.5-10mg three times daily) or fludrocortisone (0.1-0.2mg daily) may be necessary for orthostatic hypotension, while anticholinergics like oxybutynin (5mg three times daily) can help reduce detrusor overactivity in neurogenic bladder 1.
• The most recent and highest quality study, although not directly related to spinal cord infarction, highlights the importance of evaluating bladder function in individuals with autonomic neuropathy, which can inform management strategies for similar conditions 1.
• Comprehensive rehabilitation and early intervention are crucial for optimal outcomes, as they can help mitigate the imbalances in sympathetic and parasympathetic function caused by spinal cord infarcts.

Management Strategies

• For orthostatic hypotension, start with non-pharmacological measures and consider medications like midodrine or fludrocortisone if necessary.
• For neurogenic bladder, intermittent catheterization and anticholinergics like oxybutynin may be required.
• Bowel management should include a high-fiber diet, adequate hydration, and a regular evacuation schedule.
• Temperature dysregulation may require environmental modifications and careful monitoring.
• Sexual dysfunction can be addressed with medications like sildenafil (25-100mg as needed) for erectile dysfunction.
• Autonomic dysreflexia, a potentially life-threatening complication, requires immediate identification and treatment of triggers, with nifedipine (10mg) or nitrates for severe episodes 1.

From the Research

Autonomic Dysfunction Following Spinal Cord Infarction

The effects of autonomic dysfunction following spinal cord infarction can be severe and potentially life-threatening. Some of the key effects include:

• Compromised cardiovascular function, including orthostatic hypotension and episodic hypertension associated with autonomic dysreflexia 2, 3, 4, 5
• Respiratory problems, including disordered hemodynamics due to deregulated sympathetic outflow 2
• Urinary and gastrointestinal dysfunction, including bladder and urethral dysfunctions, gastric dilation, delayed gastric emptying, and diminished propulsive transit along the entire gastrointestinal tract 2
• Thermoregulatory dysfunction, including impaired body temperature regulation 6
• Sexual dysfunction, including impaired sexual function and fertility 2

Clinical Manifestations

The clinical manifestations of autonomic dysfunction following spinal cord infarction can vary depending on the level and severity of the injury. Some common manifestations include:

• Hypotension, including orthostatic hypotension and autonomic dysreflexia 3, 4, 5
• Hypertension, including episodic hypertension associated with autonomic dysreflexia 2, 5
• Urinary retention or incontinence, including neurogenic bowel dysfunction 2
• Gastrointestinal motility disorders, including gastric dilation and delayed gastric emptying 2
• Thermoregulatory dysfunction, including impaired body temperature regulation 6

Management and Treatment

The management and treatment of autonomic dysfunction following spinal cord infarction can be challenging and requires a multidisciplinary approach. Some potential treatments include:

• Medications, such as midodrine, to manage hypotension and orthostatic hypotension 4
• Lifestyle modifications, such as regular exercise and stress management, to improve cardiovascular function and reduce the risk of autonomic dysreflexia 3, 6
• Surgical interventions, such as implantation of a spinal cord stimulator, to improve bladder and bowel function 2
• Rehabilitation therapies, such as physical and occupational therapy, to improve mobility and independence 2, 6