Management of autonomic hyperreflexia of high spinal cord lesion in acute and recovery stage (author's transl)

Abstract

Autonomic hyperreflexia is a common complication of the high spinal cord lesion and sometimes may evoke convulsion, intracranial hemorrhage and death. This symptomm is found in acute and in recovery stage of spinal injury and disappeared in chronic stage.Because of this reason, total spinal block or neurotomia in the lumbar area should not be chosen at first.The purpose of this study is to find out the trigger mechanism and drug therapy of autonomic hyperreflexia, particularly in the acute and recover phases. The blood pressure, pulse rate, gross sweating, plethysmogram and the vesical pressure were observed while the bladder was filled with normal saline at a rate of 30ml per minute. Effects of phenoxybenzamine, atropine sulfate, bethanechol chloride, diazepam and percamine S were studied.The following results were obtained:1) The patients were divided into two groups. The one showed paroxysmall hypertension after increase of bladder pressure and the other showed gross sweatig without paroxysmal hypertension.2) Among the various stimulation to the patients such as catheterization of the urethra, bladder distension, etc., the most effective trigger of the autonomic hyperreflexia was the vesical contraction.3) Phenoxybenzamine, diazepam and atropine sulfate are useful in the treatment of autonomic hyperreflexia for mainly reducing the urethral resistance or preventing abnormal contration of the bladder. Administration of bethanechol chloride provoked strong bladder contraction, and this might be due to its inhibitory action on cardiovascular system and this drug did not evoke severe paroxysmal hypertension. Percamine S is effective to autonomic hyperreflexia by its action of blocking both sensory and motor nerves of the bladder.