Poster 356: Rehabilitation Challenges of a Morbidly Obese Patient with Tetraplegia: A Case Report (original) (raw)

PM&R, 2009

Abstract

labile hypertension following spinal cord injury. Program Description: Description of the use of acetylcholinesterase inhibitor in the treatment of autonomic dysfunction related orthostatic hypotension in persons with spinal cord injury. Setting: Rehabilitation Institute. Results: The initial work up included evaluation of possible causes for autonomic dysreflexia which was negative. On symptomatic treatment of hypertenison with antihypertensives, the patient developed recurrent syncopal episodes. He was hypothesized to have orthostatic hypotension with rebound hypertension secondary to autonomic dysfunction. He was started on a trial of midodrine and fludrocortisone for management of orthostatic hypotension. However,the patient now developed supine hypertension, and midodrine was discontinued. Instead, pyridostigmine, an acetylcholinesterase inhibitor was used with good results. The patient had good blood pressure control with no further episodes of labile hypertension and syncopal attacks. Discussion: Orthostatic hypotension is a known complication associated with autonomic dysfunction in spinal cord injury. Pharmacological interventions with drugs such as midodrine, a sympathomimetic, and fludrocortisone, a mineralocorticoid, are indicated when non pharmacological measures fail. In our patient diagnosed with autonomic dysfunction, a trial with midodrine caused supine hypertension and had to be discontinued. Instead, pyridostigmine, an acetylcholinesterase inhibitor, which has been found to be effective in managing neurogenic orthostatic hypotension, was used with good outcome. The mechanism of action suggested is enhanced sympathetic ganglionic transmission especially during orthostasis without causing significant supine hypertension. Conclusions: Acetylcholinesterase inhibition can be a useful pharmacological agent in the management of autonomic dysfunction in spinal cord injured persons.

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