A case of cerebellar hemorrhage secondary to autonomic dysreflexia (AD) in a patient with cervical spinal cord injury

The patient was a 72-year-old man with C4 incomplete tetraplegia incurred in a traffic accident in March, 2008. He managed his bladder with an indwelling Foley catheter. In August, 2009, the catheter obstruction induced autonomic dysreflexia (AD). Although distention of bladder disappeared immediately, cerebeller hemorrhage occurred due to AD. After an operation the patient was alive but left with disturbance of consciousness. AD is one of the most important complications of high-level spinal cord injury. The pathophysiology of AD is the disconnection of the spinal sympathetic centers from spuraspinal control, leading to unopposed, sustained sympathetic outflow below the spinal lesion. Clinically, it is characterized by an acute increase in blood pressure, headache, sweating, and facial flushing and is often triggered by nonspecific stimuli below the level of the spinal cord lesion. The main triggering factors are bladder overdistension and bowel distension. Most events subside after prompt recognition and removal of the triggering factors, but, it is a life threatening emergency that may lead to apoplexy. This life-threatening complication should be kept in mind in the patients with spinal cord injury.