Document Detail


Catecholamine-induced hypertension in lumbosacral paraplegia: five case reports.
MedLine Citation:
PMID:  10668779     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hypertension in the patient with SCI is relatively rare and generally restricted to patients with high-level injuries where autonomic dysreflexia can occur. Resting blood pressure in individuals with SCI has been described as lower than that in the normal population. This report describes five previously normotensive teenagers with subsequent paraplegia as a result of gunshot wounds who presented with hypertension secondary to idiopathic elevation of plasma or urinary catecholamine levels. A clonidine suppression test was used as a neuroprobe to inhibit centrally mediated sympathetic outflow, excluding the probability of an extra-axial autonomous catecholamine-secreting tumor as the possible source of hypertension. Positive suppression was achieved in four patients (41%, 37.2%, 4.8%, and 37.2% decreases). One patient had values corresponding to orthostatic changes (an increase of 63%) because of poor compliance with the test. This patient was lost to follow-up; in the remaining four, hypertension resolved at 12, 8, 9, and 6 weeks postinjury. The increased circulating catecholamine level appears to be promoted by a centrally mediated response to the SCI. Elevated blood pressure probably results from an upgraded receptor regulation or an increased receptor sensitivity on the affected cells in the absence of restraining spinal reflexes. The pathophysiology of such hypertension seems to be secondary to autonomic dysfunction and, although it may be transient, it should be treated promptly and reevaluated periodically until stabilization is achieved.
Authors:
W J Roche; C Nwofia; M Gittler; R Patel; G Yarkony
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Archives of physical medicine and rehabilitation     Volume:  81     ISSN:  0003-9993     ISO Abbreviation:  Arch Phys Med Rehabil     Publication Date:  2000 Feb 
Date Detail:
Created Date:  2000-02-22     Completed Date:  2000-02-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  2985158R     Medline TA:  Arch Phys Med Rehabil     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  222-5     Citation Subset:  AIM; IM    
Affiliation:
Schwab Rehabilitation Hospital and Care Network, University of Chicago Hospitals, IL, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adrenergic alpha-Agonists / diagnostic use
Adult
Blood Pressure
Catecholamines / blood*
Clonidine / diagnostic use
Humans
Hypertension / blood,  etiology*
Lumbar Vertebrae / injuries*
Lumbosacral Region
Male
Multiple Trauma / complications,  rehabilitation
Paraplegia / blood,  etiology*
Spinal Cord Injuries / complications*
Thoracic Vertebrae / injuries*
Wounds, Gunshot / complications
Chemical
Reg. No./Substance:
0/Adrenergic alpha-Agonists; 0/Catecholamines; 4205-90-7/Clonidine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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