Autonomic cardiovascular dysfunction during simple arithmetic test in a patient with cervical spinal cord injury—a case report

Spinal Cord Series and Cases, 2021 · DOI: https://doi.org/10.1038/s41394-021-00439-w · Published: August 8, 2021

Spinal Cord Injury Neurology Neurorehabilitation

Simple Explanation

Spinal cord injuries can disrupt the autonomic nervous system's control over the cardiovascular system, potentially leading to autonomic dysfunction. This disruption can cause fluctuations in blood pressure and other cardiovascular issues. Emerging research suggests that these cardiovascular changes after a spinal cord injury might contribute to cognitive problems like memory deficits and reduced attention. Autonomic dysfunction could be a factor in cognitive decline. This case report shows how a simple arithmetic task can cause blood pressure to vary in a patient with a spinal cord injury, and how this variability can affect cognitive functions. It also emphasizes how cardiovascular autonomic dysfunction can impact a person's ability to drive.

Study Duration

Not specified

Participants

A 55-year old female patient

Evidence Level

Case Report

Key Findings

1
A simple arithmetic test triggered autonomic dysfunction in a patient with a cervical medullary lesion, resulting in a drop in blood pressure.
2
The patient experienced a fall in blood pressure accompanied by reduced cognitive function during the arithmetic test, suggesting a dysfunction of the cerebrovascular reserve.
3
Treatment with Midodrine increased mean blood pressure but did not completely alleviate the patient's symptoms of hypotension.

Research Summary

This case report presents a 55-year-old woman with a non-traumatic cervical spinal cord injury who experienced autonomic cardiovascular dysfunction. A simple arithmetic test induced fluctuations in blood pressure, leading to cognitive disturbances. The patient displayed symptoms of hypotension, dizziness, and fatigue. During the arithmetic test, her blood pressure dropped, and her cognitive function declined, as evidenced by incorrect answers and reduced concentration. The findings suggest that autonomic dysfunction can contribute to cognitive deficits in patients with SCI, and treatment strategies should aim to address both cardiovascular and cognitive symptoms to improve independence and quality of life.

Practical Implications

Clinical Awareness

Increased awareness of autonomic dysfunction and cognitive deficits is crucial in neurorehabilitation for SCI patients.

Assessment of Autonomic Function

Autonomic function should be evaluated according to ISAFSCI recommendations to document remaining autonomic function after SCI.

Cognitive Screening

Mental arithmetic tests may serve as a useful screening tool for cognitive function in patients with SCI.

Study Limitations

1
Lack of validated cognitive testing prior to the arithmetic test.
2
The arithmetic test (400 take away seven) is not a validated tool for thorough cognitive assessment.
3
The patient had multiple medications at the time of testing, which may have influenced the results.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury