Autonomic dysreflexia in a patient with cold abscess of cerv
A patient with incomplete cervical cord injury,taken up for cervical spine decompression and fusion surgery, developed hypertensive crisis in operation theatre which was refractory to routine antihypertensive measures. Anaesthesia and surgery proceeded when she reasonably responded to intravenous dexmedetomidine only to have a rebound hypertension in the post-operative period which finally responded dramatically to rectal evacuation of impacted stool. Autonomic dysreflexia (AD), a potentially dangerous clinical syndrome occurs in spinal cord injury at or above the sixth thoracic vertebral level resulting in acute uncontrolled hypertension due to over activity of sympathetic nervous system below the level of injury, triggered by an ascending sensory (noxious) stimulus usually an over distended bladder in almost 85% of cases and bowel distension due to impacted stools.
A 35 year old female weighing 45 kg was having complaints of pain in the neck and weakness of all 4 limbs for 1 week. There were quadriparesis and a swelling on the left side of the neck along with tenderness in the cervical spine. Neurological examination revealed a power of 3/5 in bilateral upper and lower limbs and a sensory loss below C5 level with no bladder and bowel involvement. Rest of the clinical examination and baseline investigations were within normal limits. Based on fine needle aspiration cytology report of a caseating tubercular lesion, antitubercular treatment was started. X-ray spine showed mild cervical spondylosis with straightening of cervical curve....