Disclosures: Angela A. Samaan, DO: No financial relationships or conflicts of interest

Case Description: The patient experienced recurrent, symptomatic AD during AIR. Despite appropriate management of common triggers of AD including bladder and bowel dysfunction, pain, skin irritants and restrictive clothing/splints, the patient’s blood pressure remained uncontrolled and he frequently required nitroglycerin paste to control elevated blood pressure and secondary symptoms. During one notable episode of AD, concern for acute stroke arose as patient symptoms developed to include facial numbness with difficult to control blood pressure. Given persistent and symptomatic AD, imaging was pursued for further evaluation of spine stability in the setting of traumatic spinal cord injury. MRI of the cervical spine showed significant post-traumatic syringomyelia and spinal cord tethering (PTS-SCT). Given the absence of any other clear etiology for his recurrent AD, the PTS-SCD was thought to be contributing to the patient’s symptoms and therefore he underwent spinal cord detethering surgery.

Setting: Acute inpatient rehabilitation (AIR) unit of a tertiary care hospital.

Patient: A 54-year-old male with acute tetraplegia (C4 AIS A) complicated by recurrent autonomic dysreflexia (AD). Assessment/

Results: There were no post op complications and the patient returned to AIR where he remained symptom free without recurrence of AD. His blood pressure was adequately controlled with oral agents alone.

Discussion: Cord tethering has been suggested as a pathophysiological cause for the formation of syrinxs in the spinal cord, particularly post trauma. Subsequently, patients may present with symptoms of syringomyelia including AD. It is important to maintain a high index of suspicion for cord tethering in post traumatic SCI patients with persistent symptoms of AD. Imaging and neurosurgical evaluation may be warranted in the workup of AD of unclear etiology.

Conclusion: In a setting where AD persists despite management of common triggers, spine imaging may be indicated to evaluate for less common causes of AD such as PTS-SCT which if addressed may alleviate the recurrent AD.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cord-tethering-causing-autonomic-dysreflexia-a-case-report/