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Erschienen in:
07.04.2021 | Letter to the Editor
Recurrent stroke in a patient with spinal cord injury due to autonomic dysreflexia: a case report
Erschienen in: Acta Neurologica Belgica | Ausgabe 3/2021
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A 56-year-old man remained tetraparetic after traumatic spinal cord compression with secondary myelopathy at level C5–C7. He developed a neuropathic bladder which was managed with oxybutynin 4 mg, intermittent catherization (IC) six times a day and annual intradetrusor injection of botulinum toxin. Sixteen years after the accident, he presented now at the emergency department with sudden severe perspiration, altered mental state, generalized headache and severe hypertension. Four days earlier oxybutynin was stopped due to confusion. Brain imaging revealed a right-sided parietotemporal hemorrhage (Fig. 1a). The episode was managed by immediate lowering of the tensions with bladder catherization and intravenous nicardipine. During his hospital stay, similar additional episodes of hypertension occurred during urinary retention, typically when IC was forgotten or delayed.
Fig. 1
a Brain CT (computed tomography) scan shows the right-sided parieto-occipital hemorrhage (white star). Images b, c, d show on MRI (magnetic resonance imaging) the semi-recent cerebral ischemia in the right anterior temporal lobe, e.g., hyperintense on fluid-attenuated inversion recovery (FLAIR) sequences (white arrow) (b), hyperintense on diffusion weighted imaging (DWI) high-b-value images (c) and hypointense, more specifically cortical, on apparent diffusion coefficient (ADC) map (d)
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