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TheScientificWorldJOURNAL
Volume 11, Pages 666-672
http://dx.doi.org/10.1100/tsw.2011.55
Case Study

Infarct of the Right Basal Ganglia in a Male Spinal Cord Injury Patient: Adverse Effect of Autonomic Dysreflexia

1Regional Spinal Injuries Centre, District General Hospital, Southport, Merseyside, UK
2Department of Urology, District General Hospital, Southport, Merseyside, UK
3Department of Radiology, District General Hospital, Southport, Merseyside, UK
4Department of Cardiology, District General Hospital, Southport, Merseyside, UK

Received 7 December 2010; Revised 29 January 2011; Accepted 1 February 2011

Academic Editor: Anthony Atala

Copyright © 2011 Subramanian Vaidyanathan et al.

Abstract

Autonomic dysreflexia is a clinical emergency that occurs in individuals with spinal cord injury at level T-6 and above. We present a 58-year-old male patient with paraplegia who developed a severe, recurrent, throbbing headache during the night, which was relieved by emptying the urinary bladder by intermittent catheterisation. As this person continued to get episodes of severe headache for more than 6 months, computed tomography (CT) of the brain was performed. CT revealed an infarct measuring 1.2 cm in the right basal ganglia. In order to control involuntary detrusor contractions, the patient was prescribed propiverine hydrochloride 15 mg four times a day. The alpha-adrenoceptor blocking drug doxazosin was used to reduce the severity of autonomic dysreflexia. Following 4 weeks of treatment with propiverine and doxazosin, the headache subsided completely. We learned from this case that bladder spasms in individuals with spinal cord injury can lead to severe, recurrent episodes of autonomic dysreflexia that, in turn, can predispose to vascular complications in the brain. Therefore, it is important to take appropriate steps to control bladder spasms and thereby prevent recurrent episodes of autonomic dysreflexia. Intermittent catheterisations along with an alpha-adrenoceptor blocking drug (doxazosin) and an antimuscarinic drug (propiverine hydrochloride) helped this individual to control autonomic dysreflexia, triggered by bladder spasms during the night.