Following SPINAL CORD LESION at T6 or above a noxious stimulus below the lesion leads to unopposed sympathetic response and dangerous HYPERtension.
This may lead to convulsions, intracranial haemorrhage or arrhythmias.
Occurs in 50-90% of all cord lesions (above T6)
Noxious stimulus below lesion - splanchnic sympathetic plexus - excessive release of norepinephrine - vasoconstriction skin of abdomen and legs - marked hypertension.
Compensation (aortic arch baroreceptors via IX and X) with ↓HR and vasodilation. Cord damage prevents vasodilation so: flushing above lesion and bradycardia
Any noxious stimulus below lesion e.g. bladder distension, bowel distension, UTI, DVT, PE, pressure ulcers, fractures, cellulitis etc. etc.
Signs and symptoms
- Flushing and sweating above the lesion
- Nasal stuffiness
- Paleness and piloerection below the lesion
- Pounding headache
- Blurred vision
- Recognise the condition!
- Monitor BP
- Sit patient up, legs down
- Look for cause (bladder obstruction [change catheter], bowel obstruction [faecal loading disimpaction])
- Consider analgesia (IV opiates)
- Consider GTN spray if SBP > 150mmHg (normal for those with cord lesion is SBP 90-110 mmHg)