Spinal cord series and cases
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Spinal Cord Ser Cases · Jan 2016
Spinal fusion and antibiotic treatment illustrating lumbar osteomyelitis and spinal instability as a previously unrecognized and surgically treatable cause of autonomic dysreflexia.
Autonomic dysreflexia (AD) following spinal cord injury can lead to a physiologic state where there is unopposed sympathetic tone and subsequent hypertension, bradycardia, hyperhidrosis and anxiety. It is known to be triggered by nociceptive stimuli below the level of injury-most commonly constipation and bladder retention. We present a case of a C6-7 tetraplegic who developed AD 20 years after his injury with the unusual trigger of positional spinal instability due to osteomyelitis and discitis. ⋯ This instability in the vertebral column led to positional AD with symptom onset in extension (lying supine) and relieved with flexion (patient sitting up and bending forward). Once the trigger for his AD was determined, he was successfully treated with spinal fusion to stabilize the mobile segment and further antibiotic treatment. He had complete resolution of his AD after surgery and eradication of his infection.
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Neuromuscular weakness acquired in the intensive care unit (ICU) causes significant impairment in critically ill patients. The spectrum of critical illness neuromuscular disease includes critical illness myopathy, critical illness polyneuropathy or both, and occurs in approximately one-third of patients admitted to the ICU and those who are ventilated for at least 7 days. Recognized risk factors include sepsis, systemic inflammatory response syndrome, multi-organ failure, neuromuscular blocking agents and corticosteroids, however the absence of predisposing factors should not preclude critical illness neuromuscular disease. ⋯ The definitive diagnosis of critical illness myopathy was based on muscle biopsy demonstrating myosin filament loss. Evaluation of new-onset weakness in ICU patients is essential to distinguish neurological causes from complications of critical illness. Signs and symptoms of critical illness neuromuscular disease must be identified early to encourage recovery, promote rehabilitation, and reduce morbidity and mortality.