Orthodeoxia syndrome: a rare complication of ASD in spinal cord injury

Spinal Cord Series and Cases, 2015 · DOI: 10.1038/scsandc.2015.5 · Published: July 9, 2015

Spinal Cord Injury Cardiovascular Science Rehabilitation

Simple Explanation

This case report describes a rare instance of orthodeoxia (low blood oxygen when upright) occurring in an 81-year-old woman after a spinal cord injury. The patient had an undiagnosed atrial septal defect (ASD), a hole between the heart's upper chambers. The spinal cord injury resulted from an epidural hematoma, a complication of pain management. When the patient was mobilized, her oxygen levels dropped significantly while sitting, but returned to normal when lying down. Further investigation revealed that the ASD was causing blood to shunt from the right to the left side of her heart when she sat up, leading to the orthodeoxia. The ASD was then closed percutaneously, resolving her symptoms.

Study Duration

Not specified

Participants

Single-subject case report: 81-year-old woman

Evidence Level

Level 4: Case Report

Key Findings

1
The patient developed orthodeoxia after a spinal cord injury, which was attributed to a previously undiagnosed atrial septal defect (ASD).
2
Positional changes, specifically sitting upright, caused a reversal of blood flow through the ASD, leading to arterial desaturation.
3
Closure of the ASD resulted in the resolution of orthodeoxia symptoms and improved the patient's ability to participate in rehabilitation.

Research Summary

This case report details an 81-year-old woman who developed orthodeoxia following a spinal cord injury. The orthodeoxia was caused by a previously asymptomatic atrial septal defect (ASD). The patient experienced significant oxygen desaturation when sitting upright, which resolved upon lying down. Diagnostic testing revealed a right-to-left shunt through the ASD that was exacerbated by the upright position. Percutaneous closure of the ASD led to complete resolution of the orthodeoxia, demonstrating a direct cause-and-effect relationship and highlighting the importance of considering cardiac causes in SCI patients presenting with unexplained desaturation.

Practical Implications

Diagnostic Consideration

Orthodeoxia should be considered in SCI patients presenting with desaturation, even in the absence of postural hypotension.

Cardiac Evaluation

Detailed cardiac investigations, including echocardiography with positional changes, are warranted to rule out cardiac causes of desaturation in SCI patients.

Screening Recommendation

The authors recommend screening all new SCI patients for orthodeoxia as soon as they are able to tolerate the sitting position.

Orthodeoxia syndrome: a rare complication of ASD in spinal cord injury

Simple Explanation

Key Findings

Research Summary

Practical Implications

Diagnostic Consideration

Cardiac Evaluation

Screening Recommendation

Study Limitations

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Orthodeoxia syndrome: a rare complication of ASD in spinal cord injury

Simple Explanation

Key Findings

Research Summary

Practical Implications

Diagnostic Consideration

Cardiac Evaluation

Screening Recommendation

Study Limitations

Your Feedback

Was this summary helpful?