The author reports the case of a 36 year old man with cervical cord injury in whom
autonomic dysreflexia developed into
intracerebral hemorrhage during inpatient rehabilitation. This patient showed complete
quadriplegia (motor below C6 and sensory below C7) due to fracture of the 6th cervical vertebra. An indwelling
urethral catheter had been inserted into the bladder for 3 months, diminishing bladder expansiveness. Bladder capacity decreased to 200 ml and the patient frequently experienced
headaches whenever his bladder was full.To obtain smoother urine flow, a supra-pubic
cystostomy was performed. The
headaches were temporarily cured, but soon relapsed with extreme increases in blood pressure, representing typical symptoms of
autonomic dysreflexia. However, no potential triggers were identified or removed, and lack of blood pressure management led to left
putaminal hemorrhage. Despite operative treatment, the right upper extremity showed progressive increases in muscle tonus and finally formed a
frozen shoulder with elbow flexion
contracture. Two factors contributed to this serious complication: first,
autonomic dysreflexia triggered by minor malfunction and/or irritation from the
cystostomy catheter; and second, the medical staff lacked sufficient experience in and knowledge about the management of
autonomic dysreflexia.It is of the utmost importance for medical staff engaging in rehabilitation of spinal patients to share information regarding triggers of
autonomic dysreflexia and to be thorough in ensuring proper medical management.