Orthostatic Hypotension Management in Patients with Traumatic Cervical Myelopathy

Aim. To study the incidence and severity of orthostatic hypotension and develop a method for its correction in patients after spinal cord injury (SCI) at the cervical level. Material and мethods. The study included 120 patients after spinal cord injury at cervical level with tetraplegia C5–C8 motor levels since injury more than 1 year divided into 3 groups comparable in terms of demographic, neurological and functional parameters. The group 1 (control) received standard therapy (exercise therapy, modalities, ergotherapy, massage), the group 2 received standard therapy and permanent wearing of an abdominal bandage during the day, the group 3 received rehabilitation identical to the group 2 in conjunction with low-intensity laser therapy (reflex-segmental technique). Evaluation of the results was carried out at the beginning (T1), at the end (T2) after a 30-day rehabilitation course; in assessing the state of the ANS used heart rate variability, ABPM, tilt test, deep breathing test; the motor system was assessed using the international neurological assessment standard — ASIA Impairment Scale, the FIM motor subscale (FIMm). Results and discussion. The quantity of 35% of patients have orthostatic hypotension while subjective manifestations during the tilt test was seen only in 22% of patients. At the initial examination, there were no differences between the groups in terms of vegetative and functional status. There were no changes in neurological status in all groups, functional activity increased by 6 ± 5.4 points in the control group (FIMm), and 6 ± 4.6 and 7 ± 4.5 points in 2 and 3 groups, respectively without any the statistical differences between the groups (F = 0.51; p = 0.42) at the end of rehabilitation. There were positive changes in vegetative parameters in all groups, with the exception of the mean night systolic blood pressure (SBP) between the 1 and 2 groups. Intergroup comparison have shown positive changes in all vegetative parameters that was higher in the 2 and 3 groups: decreasing drop of SBP during tilt test was 4 ± 2.8. and 5 ± 3.2 mm Hg, increase in inspiratory- expiratory index (RRmax / RRmin) 0.5 ± 0.08 and 0.7 ± 0.10 units, increase in daytime mean SBP (ABPM) 5 ± 1.1 and 8 ± 1.4 mm Hg respectively in groups 2 and 3, against 2 ± 1.9 mm Hg. and 0.2 ± 0.05 units, 3 ± 0.9 mm Hg in the group 1. In group 3, the value and increase in RRmax / RRmin (1.21 ± 0.11; 1.23 ± 0.13; 1.27 ± 0.15, respectively, in 1, 2 and 3 groups), mean daytime SBP (105 ± 3; 108 ± 3; 110 ± 4 mm Hg, respectively in 1, 2, and 3 groups) was higher in the group 3. Conclusion. Orthostatic Hypotension (OH) occured in one third of patients in the late period after SCI at the cervical level, the method of OH management that included daytime abdominal bandage wearing and using low-intensity laser radiation (905 nm, 50 Hz) on the cardioreflex zones has shown its preliminary effectiveness.</jats:p

Autonomic dysreflexia in the practice of a urologist

Autonomic dysreflexia (AD) is a potentially life-threatening condition that develops in patients with spinal cord injury (SCI) at or above the T6 segment. First of all this condition is characterized by uncontrolled arterial hypertension, which can lead to catastrophic complications and even death. The trigger for the development of AD is often urological complications, as well as diagnostic and therapeutic manipulations on the lower urinary tract. It is important for urologists to be aware of the AD syndrome, clinical features of AD, acute and chronic management, as well as prevention episodes of AD in patients with neurogenic lower urinary dysfunction. AD is defined as an increase of systolic blood pressure of 20 mmHg from baseline in response to various afferent stimuli originating below the level of spinal cord injury. AD is based on exaltation of spinal reflex activity with irradiation of impulses in the spinal cord under conditions of dennervation preganglionic sympathetic neurons located above the T6 segment and hyperactivity of peripheral -adrenergic receptors. The main pathophysiological mechanism of AD is hypernoradrenalinemia, leading to vasoconstriction of the vessels of the skin, abdominal cavity, muscles below the level of neurological injury.</jats:p

Progressive posttraumatic cystic myelopathy (clinical case)

Посттравматическая прогрессирующая сирингомиелия – редкое состояние, возникающее после спинномозговой травмы, приводящее к нарастанию неврологического дефицита и утяжелению инвалидизации. В патогенезе лежит образование одиночной большой кисты, множественных небольших кист или размягчение спинного мозга (миеломаляция). В статье приводится описание клинического случая прогрессирующей восходящей пост-травматической сирингомиелии. Обсуждаются вопросы клинической картины, характера течения, особенностей диагностики и результаты лечения данного состояния. Ключевые слова: спинномозговая травма, прогрессирующая посттравматическая миелопатия, посттравматическая сирингомиелия. Для цитирования: Бушков Ф.А., Бжилянский М.А. Прогрессирующая посттравматическая сирингомиелия. Consilium Medicum. 2020; 22 (9): 87–90. DOI: 10.26442/20751753.2020.9.200268</jats:p

Intermittent catheterization of the bladder with tetraplegia due to spinal cord injury

Aim. Identify ways of urinary diversion and factors affecting the use of intermittent catheterization in patients with tetraplegia. Materials and methods. 31 patients participated in the examination with tetraplegia, under rehabilitation in Rehab center "Preodolenie" in 2017–2018, with neurological level corresponding to the C4–D1 segments of the spinal cord. All patients were assigned intermittent bladder catheterization, based on urodynamic examination data. Patients with an intact plucking of the fingers were engaged with the ergotherapist in mastering the skill of performing bladder catheterization on their own. 6 (12) months after discharge from the in-patient facility, patients were questioned by phone using the Neurogenic Bladder Symptom Score (NBSS). These data were compared with the conclusion of the ergotherapist and the results of a retrospective neurological examination (American Spinal Injury Association Neurological Standard – ASIA). Results. At the time of the survey, patients had urinary reflex urination with the prevailing methods of urine discharge – 39% (category D on the NBSS scale) and periodic catheterization (category C on the NBSS scale) – 32%. The only factor affecting the popularity of intermittent catheterization is the presence of the skill of its implementation directly by the patient (correlation coefficient R=0.86), which in turn depends only on the completeness of damage to the spinal cord (ASIA 1.20 vs 1.14; p=0.04); the quality of life of patients with neurogenic impaired urination was higher with an incomplete type of damage (C and D types according to ASIA; criterion F=3.1; p=0.04). Conclucion. Among the factors affecting the adherence of patients to the prescribed method of urine discharge, the skill of self-fulfillment and social reasons associated with the complexity of organizing the implementation of intermittent catheterization of the bladder at home is of paramount importance