AUTONOMIC HYPERREFLEXIA AND ITS CONTROL IN PATIENTS WITH SPINAL CORD LESIONS

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Abstract
Patients with cervical cord injuries commonly suffer from autonomic hyperreflexia analogous to the somatic hyperreflexia which follows release from inhibition by higher centers. The autonomic hyperreflexia is manifested by paraoxysms of hypertension, excessive diaphoresis and visceral spasms. The first, which is ineffectively combated by the intact cardio-depressor mechanisms, may present a threat to life, while the latter effects interfere with rehabilitation and, particularly, with urinary bladder and bowel care. The pelvic viscera appear to be particularly effective triggers for the autonomic responses, but many other sites are also effective, including simply stroking of the skin. Ganglionic blockade with a moderately long-acting agent (hexamethonium) provides reasonably satisfactory substitution for the lost inhibition from higher centers. Adreno-lytic agents proved ineffective. Results of therapy on 33 patients with oral and 38 with parenteral hexamethonium illustrate the control of the complaints. Diaphoresis and visceral spasms are readily obliterated, while the paroxysms of hypertension are usually controlled. The only objectionable side effect was postural hypotension, which was commonly present before therapy and became exaggerated during exhibition of the drug. In addition to symptomatology, responses were measured by cold pressor tests and cystometrography with simultaneous blood pressure and pulse observation. Dramatic effects in reducing bladder spasm, increasing urinary capacity and reducing blood pressure rise were seen.