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Autonomic Dysreflexia

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Andrei V Krassioukov – One of the best experts on this subject based on the ideXlab platform.

  • prediction of Autonomic Dysreflexia during urodynamics a prospective cohort study
    BMC Medicine, 2018
    Co-Authors: Matthias Walter, S Knupfer, Jacquelyn J Cragg, Lorenz Leitner, Marc P Schneider, Ulrich Mehnert, Andrei V Krassioukov, Martin Schubert

    Abstract:

    Autonomic Dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to assess neurogenic lower urinary tract dysfunction due to spinal cord injury and reveal crucial pathological findings, such as neurogenic detrusor overactivity. However, neurogenic detrusor overactivity and urodynamic investigation are known to be leading triggers of Autonomic Dysreflexia. Therefore, we aimed to determine predictors of Autonomic Dysreflexia in individuals with spinal cord injury during urodynamic investigation. This prospective cohort study included 300 patients with spinal cord injuries and complete datasets of continuous non-invasive cardiovascular monitoring, recorded during same session repeat urodynamic investigation. We used logistic regression to reveal predictors of Autonomic Dysreflexia during urodynamic investigation. We found that level of injury and presence of neurogenic detrusor overactivity were the only two independent significant predictors for Autonomic Dysreflexia during urodynamic investigation. A lesion at spinal segment T6 or above (odds ratio (OR) 5.5, 95% CI 3.2–9.4) compared to one at T7 or below, and presence of neurogenic detrusor overactivity (OR 2.7, 95% confidence interval (CI) 1.4–4.9) were associated with a significant increased odds of Autonomic Dysreflexia during urodynamic investigation. Both odds persisted after adjustment for age, sex, and completeness and stage of injury (adjusted OR (AOR) 6.6, 95% CI 3.8–11.7, and AOR 2.2, 95% CI 1.1–4.5, respectively). Further stratification by lesion level showed level-dependent significantly increased adjusted odds of Autonomic Dysreflexia, i.e., from C1–C4 (AOR 16.2, 95% CI 5.9–57.9) to T4–T6 (AOR 2.6, 95% CI 1.3–5.2), compared to lesions at T7 or below. In patients with neurogenic lower urinary tract dysfunction due to spinal cord injury, Autonomic Dysreflexia is independently predicted by lesion level and presence of neurogenic detrusor overactivity. Considering the health risks associated with Autonomic Dysreflexia, such as seizures, stroke, retinal bleeding, or even death, we recommend both continuous cardiovascular monitoring during urodynamic investigation in all spinal cord-injured patients with emphasis on those with cervical lesions, and appropriate neurogenic detrusor overactivity treatment to reduce the probability of potentially life-threatening complications. ClinicalTrials.gov, NCT01293110
    .

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  • Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury.
    Journal of Neurotrauma, 2016
    Co-Authors: Renee J. Fougere, Katharine D. Currie, Mark Nigro, Lynn Stothers, Daniel Rapoport, Andrei V Krassioukov

    Abstract:

    Abstract Bladder-related events, including neurogenic detrusor overactivity, are the leading cause of Autonomic Dysreflexia in spinal cord injured individuals. Self-reported Autonomic Dysreflexia is reduced following onabotulinumtoxinA treatment for neurogenic detrusor overactivity; however, none of these trials have assessed Autonomic Dysreflexia events using the clinical cutoff of an increase in systolic blood pressure ≥20 mm Hg. This study used a prospective, open-labelled design from 2013 to 2014 to quantitatively assess the efficacy of one cycle 200 U intradetrusor-injected onabotulinumtoxinA (20 sites) on reducing the severity and frequency of bladder-related Autonomic Dysreflexia events and improving quality of life. Twelve men and five women with chronic, traumatic spinal cord injuries at or above the sixth thoracic level, and concomitant Autonomic Dysreflexia and neurogenic detrusor overactivity, underwent blood pressure monitoring during urodynamics and over a 24 h period using ambulatory blood …

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  • Online training improves paramedics’ knowledge of Autonomic Dysreflexia management guidelines.
    Spinal Cord, 2016
    Co-Authors: K A Martin Ginis, Jennifer R Tomasone, Michelle Welsford, Karen Ethans, Adrienne R. Sinden, M Longeway, Andrei V Krassioukov

    Abstract:

    Online training improves paramedics’ knowledge of Autonomic Dysreflexia management guidelines

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Jacquelyn J Cragg – One of the best experts on this subject based on the ideXlab platform.

  • prediction of Autonomic Dysreflexia during urodynamics a prospective cohort study
    BMC Medicine, 2018
    Co-Authors: Matthias Walter, S Knupfer, Jacquelyn J Cragg, Lorenz Leitner, Marc P Schneider, Ulrich Mehnert, Andrei V Krassioukov, Martin Schubert

    Abstract:

    Autonomic Dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to assess neurogenic lower urinary tract dysfunction due to spinal cord injury and reveal crucial pathological findings, such as neurogenic detrusor overactivity. However, neurogenic detrusor overactivity and urodynamic investigation are known to be leading triggers of Autonomic Dysreflexia. Therefore, we aimed to determine predictors of Autonomic Dysreflexia in individuals with spinal cord injury during urodynamic investigation. This prospective cohort study included 300 patients with spinal cord injuries and complete datasets of continuous non-invasive cardiovascular monitoring, recorded during same session repeat urodynamic investigation. We used logistic regression to reveal predictors of Autonomic Dysreflexia during urodynamic investigation. We found that level of injury and presence of neurogenic detrusor overactivity were the only two independent significant predictors for Autonomic Dysreflexia during urodynamic investigation. A lesion at spinal segment T6 or above (odds ratio (OR) 5.5, 95% CI 3.2–9.4) compared to one at T7 or below, and presence of neurogenic detrusor overactivity (OR 2.7, 95% confidence interval (CI) 1.4–4.9) were associated with a significant increased odds of Autonomic Dysreflexia during urodynamic investigation. Both odds persisted after adjustment for age, sex, and completeness and stage of injury (adjusted OR (AOR) 6.6, 95% CI 3.8–11.7, and AOR 2.2, 95% CI 1.1–4.5, respectively). Further stratification by lesion level showed level-dependent significantly increased adjusted odds of Autonomic Dysreflexia, i.e., from C1–C4 (AOR 16.2, 95% CI 5.9–57.9) to T4–T6 (AOR 2.6, 95% CI 1.3–5.2), compared to lesions at T7 or below. In patients with neurogenic lower urinary tract dysfunction due to spinal cord injury, Autonomic Dysreflexia is independently predicted by lesion level and presence of neurogenic detrusor overactivity. Considering the health risks associated with Autonomic Dysreflexia, such as seizures, stroke, retinal bleeding, or even death, we recommend both continuous cardiovascular monitoring during urodynamic investigation in all spinal cord-injured patients with emphasis on those with cervical lesions, and appropriate neurogenic detrusor overactivity treatment to reduce the probability of potentially life-threatening complications. ClinicalTrials.gov, NCT01293110
    .

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  • pearls oy sters transient horner syndrome associated with Autonomic Dysreflexia
    Neurology, 2013
    Co-Authors: Jacquelyn J Cragg, Andrei V Krassioukov

    Abstract:

    Autonomic Dysreflexia is a potentially life-threatening condition that occurs in individuals with high thoracic and cervical spinal cord injuries (SCIs) and is characterized by severe episodic hypertension.

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  • Pearls & Oy-sters: Transient Horner syndrome associated with Autonomic Dysreflexia
    Neurology, 2013
    Co-Authors: Jacquelyn J Cragg, Andrei V Krassioukov

    Abstract:

    Autonomic Dysreflexia is a potentially life-threatening condition that occurs in individuals with high thoracic and cervical spinal cord injuries (SCIs) and is characterized by severe episodic hypertension.

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Inder Perkash – One of the best experts on this subject based on the ideXlab platform.

  • transurethral sphincterotomy provides significant relief in Autonomic Dysreflexia in spinal cord injured male patients long term followup results
    The Journal of Urology, 2007
    Co-Authors: Inder Perkash

    Abstract:

    Purpose: An evaluation of the results of transurethral sphincterotomy in spinal cord injured patients for the relief of Autonomic Dysreflexia is presented.Materials and Methods: The study describes experience with the treatment of 46 consecutive spinal cord injured males presenting with frequent symptoms of Autonomic Dysreflexia and inadequate voiding. The selection criteria include patients injured above the thoracic 6 level with subjective symptoms of Autonomic Dysreflexia who did not want to be catheterized or were unable to perform intermittent catheterization. Patients were studied with complex urodynamics before and at least 3 months after undergoing transurethral sphincterotomy. During cystometrogram the maximum increase in systolic and diastolic blood pressure was recorded. After transurethral sphincterotomy patients were followed for a mean of 5.4 ± 3.1 years (range 1 to 12).Results: There was subjective relief in Autonomic Dysreflexia following transurethral sphincterotomy in all patients, which…

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