Disclosures: Marla A. Petriello, DO: No financial relationships or conflicts of interest

Case Diagnosis: A 24-year-old previously healthy male with a newly sustained L1 American Spinal Injury Association Impairment Scale (AIS) grade C spinal cord injury (SCI) presents to acute inpatient rehabilitation with tachycardia and hypertension attributed to dysautonomia.

Case Description or Program Description: A 24-year-old male presented with multiple gunshot wounds to the chest, back, and upper extremities. He was found to have a bullet fragment in the T12 vertebral body extending into the spinal canal resulting in an L1 AIS C SCI. He underwent T12-L1 laminectomy and transferred to acute inpatient rehabilitation. While in rehabilitation, he was noted to have labile hypertension with systolic blood pressure up to 180s associated with rapid elevations in heart rate and diaphoresis. Additionally, he experienced abdominal bloating and suprapubic discomfort. CT of the abdomen and pelvis was obtained due to concern for infected sacral ulcer however this was negative. Lab work revealed no leukocytosis or signs of dehydration. He was started on a bowel program and began intermittent catheterization, and his pain was controlled on oral medications, however tachycardia and hypertension continued.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: After ruling out infection and controlling pain and other etiologies of tachycardia and hypertension, the patient was diagnosed with dysautonomia. He was started on propranolol with improved heart rate and blood pressure.

Discussion (relevance): Dysautonomia is a common complication for patients with spinal cord injuries at higher thoracic and cervical levels, however here we present a case of a patient with a lumbar SCI with significant dysautonomia impacting rehabilitation and activities of daily living (ADLs). Once the patient started on appropriate pharmacotherapy, he had a significantly improved heart rate and blood pressure and ability to participate in therapy.

Conclusions: Dysautonomia should be considered in all patients with acute spinal cord injuries presenting with fluctuations in blood pressure and heart rate.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/dysautonomia-in-a-patient-with-l1-ais-c-spinal-cord-injury-a-case-report/