Recurrent syncope secondary to autonomic dysfunction in spinal cord injury: a case report

Spinal Cord Series and Cases, 2023 · DOI: https://doi.org/10.1038/s41394-023-00585-3 · Published: June 22, 2023

Spinal Cord Injury Cardiovascular Science Neurology

Simple Explanation

High-level spinal cord injuries can disrupt the autonomic nervous system, leading to orthostatic hypotension and syncope. This report describes a tetraplegic man with recurrent syncopal events due to autonomic failure following a spinal cord injury. The patient's syncope significantly interfered with his rehabilitation, raising concerns about his ability to return home safely.

Study Duration

Not specified

Participants

A 66-year-old tetraplegic man

Evidence Level

Level 4: Case Report

Key Findings

1
The patient experienced frequent syncopal events with low blood pressure, despite initial treatment for orthostatic hypotension.
2
Bedside autonomic function testing suggested impaired sympathetic autonomic and cardiovagal responses.
3
Increasing midodrine, aggressive hydration, compression stockings, and adjusting therapy times reduced the frequency of syncope.

Research Summary

This case report describes a patient with a C6 spinal cord injury who experienced recurrent syncope due to autonomic dysfunction. Investigations revealed impaired sympathetic and cardiovagal responses, and treatment focused on managing autonomic dysfunction reduced the frequency of syncopal events. The case highlights the importance of considering autonomic dysfunction in patients with spinal cord injury who experience syncope, even years after the initial injury.

Practical Implications

Comprehensive Investigation

Detailed investigation of cardiogenic, neurogenic, and autonomic causes of syncope is warranted in spinal cord injury patients.

Autonomic Dysfunction Consideration

Clinicians should consider autonomic dysfunction as a potential cause of syncope in patients with spinal cord injury.

Tailored Management Plans

Management plans should address autonomic dysfunction, potentially including midodrine, hydration, compression, and modified therapy schedules.

Study Limitations

1
Formal autonomic testing was not performed due to the patient's tetraplegia and limitations of the autonomic laboratory.
2
Sitting renin and aldosterone levels were not collected.
3
The precise contribution of COVID-19 to the patient's symptoms could not be definitively quantified.

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