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Surg Neurol Int 2018 24;9:258. Epub 2018 Dec 24.

Department of Neurosurgery, Juha Hernesniemi International Neurosurgery Center, Henan Provincial People's Hospital, 7 Weiwu Road, Zhengzhou, China.

Background: There is scant literature describing the management of acute spinal injury in pregnant patients. Here, we report our experience with five cases of pregnant patients including three females who suffered acute traumatic spinal cord injuries (SCIs).

Methods: This retrospective study evaluated five pregnant women presenting with traumatic spinal injuries over a 16-month period. Read More

BMJ Open 2018 Nov 21;8(11):e024084. Epub 2018 Nov 21.

International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Introduction: Managing and preventing risk factors associated with cardiovascular and cerebrovascular impairment is well studied in able-bodied individuals. However, individuals with spinal cord injury (SCI) at or above the spinal segment T6 are prone to experience autonomic dysreflexia (AD) but also to suffer from neurogenic detrusor overactivity (NDO). Treatment of NDO would not only improve lower urinary tract function but could also reduce the severity and frequency of life-threatening episodes of AD. Read More

Acta Vet Scand 2018 Oct 29;60(1):64. Epub 2018 Oct 29.

Department of Animal Medicine, Production and Health, University of Padua, Viale dell'Università 16, 35020, Legnaro, PD, Italy.

Background: The trigeminocardiac reflex (TCR) is a brainstem reflex that may be observed in anaesthesia during surgical procedures stimulating the intracranial or peripheral portion of the trigeminal nerve. The peripheral TCR is divided into the oculocardiac reflex and the maxillomandibulocardiac reflex based on the affected sensory branches of the trigeminal nerve. In veterinary medicine the oculocardiac reflex has been described, however the maxillomandibulocardiac reflex has never been reported. Read More

J Neurotrauma 2019 Jan 8. Epub 2019 Jan 8.

Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania.

Selection of a proper spinal cord injury (SCI) rat model to study therapeutic effects of cell transplantation is imperative for research in cardiovascular functional recovery, due to the local harsh milieu inhibiting cell growth. We recently found that a crushed spinal cord lesion can minimize fibrotic scarring and grafted cell death compared with open-dura injuries. To determine if this SCI model is applicable for studying cardiovascular recovery, we examined hemodynamic consequences following crushed SCI and tested cardiovascular responses to serotonin (5-HT) or dopamine (DA) receptor agonists. Read More

J Med Eng Technol 2018 Oct 16:1-8. Epub 2018 Oct 16.

a Medical Physics Department , James Cook University Hospital , Middlesbrough , UK.

Patients with a spinal cord injury above the 6th thoracic vertebrae may be prone to autonomic dysreflexia (AD) in response to bladder stimulus associated with a urodynamics investigation. It is essential that these patients are managed carefully in the urodynamics clinic in order to prevent life-threatening hypertension and bradycardia. Part of this management is the measurement and manual recording of pulse rate (PR) and non-invasive blood pressure (NIBP), alongside the standard urodynamics data set. Read More

Exp Neurol 2019 Jan 10;311:173-181. Epub 2018 Oct 10.

Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany; Institute for Biology, University of Lübeck, Lübeck, Germany.

Autonomic dysreflexia (AD), a syndrome caused by loss of supraspinal control over sympathetic activity and amplified vascular reflex upon sensory stimuli below injury level, is a major health problem in high-level spinal cord injury (SCI). After supraspinal sympathetic control of the vasculature below the lesion is lost, the renin-angiotensin system (RAS) is thought to be involved in AD by regulating blood pressure and vascular reactivity. In this study, we aimed to assess the role of different RAS receptors during AD following SCI. Read More

Spinal Cord Ser Cases 2018 11;4:83. Epub 2018 Sep 11.

Department of Urology, University of Washington, Seattle, WA USA.

Study Design: Case series.

Objective: Bladder chemodenervation is effective in treating neurogenic detrusor overactivity (NDO) in patients with neurogenic bladder due to spinal cord injury. Anecdotal reports also describe the improvement of non-bladder symptoms, specifically those related to autonomic dysreflexia (AD) and muscle spasticity. Read More

J Spinal Cord Med 2018 Sep 10:1-4. Epub 2018 Sep 10.

c Kessler Institute for Rehabilitation , West Orange , New Jersey , USA.

Context: Autonomic dysreflexia (AD) is characterized by a sudden onset of hypertension in those with spinal cord injuries (SCI) at T6 or above. Prompt recognition and treatment of AD is important. Herein are two individuals with SCI and acute hypertension due to anxiety that may easily have been confused for AD. Read More

J Spinal Cord Med 2018 Sep 10:1-5. Epub 2018 Sep 10.

c Kessler Institute for Rehabilitation , West Orange, West Orange , New Jersey , USA.

Objective: To evaluate the role of intravesical lidocaine in preventing autonomic dysreflexia (AD) during routine catheter changes in individuals with spinal cord injury (SCI) at T6 or above.

Design: Prospective observational cohort study.

Setting: Outpatient urology clinic. Read More

J Spinal Cord Med 2018 Aug 20:1-8. Epub 2018 Aug 20.

b Department of Rehabilitation Medicine , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands.

Context/objective: Since life expectancy of persons with spinal cord injury (SCI) has improved, it is relevant to know whether this group is able to maintain functional abilities many years after onset of SCI. Objectives of this study were (1) to examine associations between time since injury (TSI) and functional independence in persons with long-standing SCI and (2) to explore associations between functional independence and level of injury, comorbidities, mental health, waist circumference and secondary health conditions (SHCs).

Design: TSI-stratified cross-sectional study. Read More

J Spinal Cord Med 2018 Aug 20:1-4. Epub 2018 Aug 20.

a Department of Physical Medicine and Rehabilitation , Penn State Health Milton S. Hershey Medical Center , Hershey , Pennsylvania , USA.

Context: Autonomic dysreflexia and dysautonomia can be a common complication following spinal cord injury, especially at levels of T6 and above and can lead to complications associated with the pupil. In this case report, we review autonomic dysreflexia, the anatomy and physiology of the sympathetic nervous system of the eye, as well as review the clinical relevance in understanding autonomic and pupillary changes in response to autonomic dysfunction.

Findings: We present a patient with an incomplete C4 level injury who was found to have isolated anisocoria on two separate occasions during his acute inpatient rehabilitation stay. Read More

J Neurotrauma 2018 Dec 8;35(24):2861-2871. Epub 2018 Sep 8.

1 International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.

Spinal cord injury (SCI) is a devastating neurological condition for which there is no effective treatment to restore neurological function. The development of new treatments for those with SCI may be hampered by the insensitivity of clinical tools to assess motor function in humans. Treatments aimed at preserving neuronal function through anti-inflammatory pathways (i. Read More

Med Sci Sports Exerc 2018 Dec;50(12):2398-2400

School of Kinesiology, University of British Columbia, Vancouver, BC, CANADA.

Boosting is the induction of autonomic dysreflexia (AD) to reflexively activate otherwise dormant thoracolumbar sympathetic circuitry to "boost" the capacity of the cardiovascular system and enhance exercise performance. AD is a life-threatening condition unique to individuals with spinal cord injury (SCI) characterized by a sudden increase in sympathetic activity below the level of the SCI. Here we report on the temporal HR response to an episode of unintentional boosting during a validated field-based exercise performance test in an athlete with tetraplegia. Read More

PM R 2018 Jul 21. Epub 2018 Jul 21.

University of Washington, Spinal Cord Injury Service, VA Puget Sound Health Care System, 1660 S Columbian Way, S-128-SCI, Seattle, WA 98108. Electronic address:

Pharmacologic triggers of autonomic dysreflexia (AD) have rarely been described. This report describes the case of a 31-year-old woman with T3 American Spinal Injury Association Impairment Scale grade A spinal cord injury who developed recurrent AD while receiving duloxetine and amitriptyline combination therapy for neuropathic pain. After excluding other AD generators, duloxetine was discontinued and the AD episodes resolved. Read More

J Neuroimmunol 2018 Aug 24;321:1-11. Epub 2018 May 24.

Department of Neuroscience, Center for Brain and Spinal Cord Repair, Wexner Medical Center, The Ohio State University, Columbus 43210, OH, USA. Electronic address:

Traumatic spinal cord injury (SCI) causes widespread damage to neurons, glia and endothelia located throughout the spinal parenchyma. In response to the injury, resident and blood-derived leukocytes orchestrate an intraspinal inflammatory response that propagates secondary neuropathology and also promotes tissue repair. SCI also negatively affects autonomic control over peripheral immune organs, notably the spleen. Read More

World J Urol 2018 Oct 14;36(10):1577-1585. Epub 2018 Jun 14.

University of British Columbia, Vancouver, BC, Canada.

Background: After a spinal cord injury, patients have different perceptions of sexuality, sexual function, and potential for fertility. These changes can greatly impact quality of life over a lifetime.

Purpose: The purpose of this workgroup was to identify common evidence based or expert opinion themes and recommendations regarding treatment of sexuality, sexual function and fertility in the spinal cord injury population. Read More

Surg Neurol Int 2018 29;9:113. Epub 2018 May 29.

Department of Neurosurgery, University of Cincinnati College of Medicine, and Mayfield Clinic, Cincinnati, Ohio, USA.

Background: Charcot spinal arthropathy (CSA) clearly represents a challenge in long-term spinal cord injury patients, one that can have extremely uncomfortable and potentially lethal outcomes if not managed properly.

Case Description: A 66-year-old man with a history of complete C7 quadriplegia presented with new-onset autonomic dysreflexia that resulted from Charcot spinal arthropathy (CSA). Pathologic instability, in the atypical site of the mid-thoracic spine, spanning from the T8-T9 vertebral levels was appreciated on physical exam as an audible, palpable, and visible dynamic kyphosis; kyphosis was later confirmed on neuroimaging. Read More

J Spinal Cord Med 2018 Jun 20:1-4. Epub 2018 Jun 20.

b Vesia [Alberta Bladder Centre], Department of Surgery , University of Calgary , Calgary, Alberta , Canada.

Context: Autonomic dysreflexia is a potentially lethal condition experienced by spinal cord injury (SCI) patients. It has a wide range of causes, most of which are genitourinary in nature. However, there has been no documented case of primary bladder cancer as a trigger for recurrent autonomic dysreflexia. Read More

J Emerg Med 2018 08 26;55(2):206-212. Epub 2018 May 26.

Department of Rehabilitation Medicine, Magee Rehabilitation Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.

Background: Persons with spinal cord injuries (SCIs) are frequent utilizers of emergency medical services but are a poorly understood and medically complex population. As the treatment of acute spinal cord injuries improves, there is a growing population of patients suffering from the chronic neurological deficits and altered homeostasis resulting from those injuries.

Objectives: We sought to highlight the unique diagnostic challenges of treating persons with SCIs and to review ailments uncommon in the general population but often encountered in this population. Read More

PM R 2018 Dec 23;10(12):1368-1379. Epub 2018 May 23.

Kent State University, Kent, OH; and Louis Stokes Cleveland VA Medical Center, Cleveland, OH(#).

Background: Blood flow restriction (BFR) exercise, which already has shown promise in the able-bodied population, may be a novel method for improving muscle function in the incomplete spinal cord injury (iSCI) population. However, the feasibility and tolerance for BFR exercise in this population is unknown.

Objective: To determine the feasibility and safety of BFR exercise in the iSCI population, with special attention paid to acute hemodynamic changes and the risk of deep vein thrombosis (DVT). Read More

J Hum Lact 2018 Aug 22;34(3):556-565. Epub 2018 May 22.

2 Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

Background: Lactation dysfunction following spinal cord injury has been noted in the literature. However, researchers have often grouped together all women of physical disability or do not account for injury level. The extent of lactation dysfunction and influence of spinal cord injury on breastfeeding ability and behavior is not well understood. Read More

J Spinal Cord Med 2018 May 7:1-10. Epub 2018 May 7.

c Toronto Rehabilitation Institute, Lyndhurst Centre , University Health Network , Toronto , Ontario , Canada.

Objective: To identify a set of essential components for primary care for patients with spinal cord injury (SCI) for inclusion in a point-of-practice toolkit for primary care practitioners (PCP) and identification of the essential elements of SCI care that are required in primary care and those that should be the focus of specialist care.

Design: Modified Delphi consensus process; survey methodology.

Setting: Primary care. Read More

Mult Scler Relat Disord 2018 Jul 16;23:1-3. Epub 2018 Apr 16.

Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Toronto, Ontario, M4G 3V9, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Canada. Electronic address:

Background: Cardiovascular autonomic dysfunction is a relatively common secondary complication of tetraplegia. In addition to low baseline arterial blood pressure, tetraplegics can develop sudden-onset hypertensive episodes associated with a variety of symptoms and signs (so-called autonomic dysreflexia). Unfortunately, this potentially life-threatening medical entity is often overlooked and mismanaged. Read More

BMC Med 2018 04 13;16(1):53. Epub 2018 Apr 13.

Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.

Background: Autonomic dysreflexia is a severe and potentially life-threatening condition in patients with spinal cord injury, as it can lead to myocardial ischemia, brain hemorrhage, or even death. Urodynamic investigation is the gold standard to assess neurogenic lower urinary tract dysfunction due to spinal cord injury and reveal crucial pathological findings, such as neurogenic detrusor overactivity. However, neurogenic detrusor overactivity and urodynamic investigation are known to be leading triggers of autonomic dysreflexia. Read More

Spinal Cord Ser Cases 2018 4;4:31. Epub 2018 Apr 4.

1Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN UK.

Introduction: Persistent urine leakage after suprapubic cystostomy in tetraplegic subjects occurs due to shrinkage of the urinary bladder and bladder spasms. The patient's social life is adversely affected as clothes become wet, smelly, and require frequent changing, thus increasing the workload of carers.

Case Presentation: A 48-year-old male sustained C-4 complete (AIS:A) tetraplegia while swimming in 2007. Read More

J Neurosci 2018 Apr 2;38(17):4146-4162. Epub 2018 Apr 2.

Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania 19129,

Cardiovascular disease and susceptibility to infection are leading causes of morbidity and mortality for individuals with spinal cord injury (SCI). A major contributor to these is autonomic dysreflexia (AD), an amplified reaction of the autonomic nervous system (hallmarked by severe hypertension) in response to sensory stimuli below the injury. Maladaptive plasticity of the spinal sympathetic reflex circuit below the SCI results in AD intensification over time. Read More

Int Med Case Rep J 2018 7;11:53-58. Epub 2018 Mar 7.

Regional Spinal Injuries Centre.

Introduction: Over-distension of urinary bladder in a high spinal cord injury patient is a triggering factor for autonomic dysreflexia. Removing triggering factors is vital to prevent autonomic dysreflexia.

Case Presentation: A 36-year-old tetraplegic patient, who was managed by intermittent catheterizations performed by caregivers, developed recurrent autonomic dysreflexia during a week due to: 1) carers not performing intermittent catheterizations every night; 2) infrequent catheterizations during the day, leading to distension of urinary bladder. Read More

Spinal Cord 2018 08 7;56(8):777-789. Epub 2018 Mar 7.

Pulmonary and Critical Care Medicine Division, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, 48109, USA.

Study Design: Prospective, cohort study.

Objectives: To evaluate the effectiveness of bi-level positive airway pressure (PAP) therapy and the patterns of use for sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI).

Setting: Academic tertiary care center, USA. Read More

J Spinal Cord Med 2018 Feb 27:1-10. Epub 2018 Feb 27.

c Faculty of Medicine , University of Rijeka , Rijeka , Croatia.

Context/objective: Autonomic dysreflexia is a clinical syndrome affecting persons with spinal cord lesions. The aim of the study was to detect the level of knowledge among students about autonomic dysreflexia in persons with spinal cord lesions.

Design: Single centre questionnaire study. Read More

J Spinal Cord Med 2018 Feb 9:1-7. Epub 2018 Feb 9.

a Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital , Ontario , Canada.

Objective: Context/Objective: Family physicians may lack the knowledge or resources to adequately support patients with spinal cord injury (SCI). Our objectives were to determine patterns of preventive care for patients with SCI in a primary care setting (i.e. Read More

Spinal Cord Ser Cases 2017 29;3:17102. Epub 2017 Dec 29.

Department of Orthopedic Surgery, University of California, San Francisco, CA 94143 USA.

Introduction: Autonomic dysreflexia (AD) is a well-known sequela of high spinal cord injuries (SCI). The characteristic episodic presentation is one of increased sympathetic tone: diaphoresis, hypertension, tachycardia, or reflex bradycardia. The episodes are triggered by visceral sensations and can last days to weeks. Read More

Spinal Cord Ser Cases 2017 28;3:17101. Epub 2017 Dec 28.

International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC V1Y 1T3 Canada.

Introduction: Many individuals with high-level spinal cord injury (SCI) experience secondary conditions such as autonomic dysreflexia (AD), which is a potentially life-threatening condition comprising transient episodes of hypertension up to 300 mmHg. AD may be accompanied by symptoms and signs such as headache, flushing, and sweating. Delay in AD recognition and management is associated with increased incidence of cardiovascular events and disease. Read More

Spinal Cord Ser Cases 2017 6;3:17087. Epub 2017 Dec 6.

Spinal Unit, Centre Calve, Foundation Hopale, Berck-sur-Mer, France.

Introduction: Spinal cord injury (SCI) creates a complex and unique syndrome of medical issues related to disruption of somatic and autonomic pathways. Among these impaired control of blood pressure (BP) can significantly impede patients' activities of daily living. The International Standards for the Assessment of Autonomic Function after SCI (ISAFSCI) is used to document the impact of SCI on resting BP (abnormal if below 90 mmHg) and the presence or absence of orthostatic hypotension (OH), defined as a symptomatic or asymptomatic decrease in BP (>/=20/10 mmHg) upon moving to an upright position. Read More

Spinal Cord Ser Cases 2017 14;3:17080. Epub 2017 Nov 14.

2Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI USA.

Introduction: Patients with spinal cord injury (SCI), especially those with injury at and above T6, are prone to transient episodes of hypertension induced by noxious triggers below the level of SCI, known as autonomic dysreflexia (AD). An uncommonly reported presentation of AD is posterior reversible encephalopathy syndrome (PRES).

Case Presentation: A 50-year-old male with the history of paraplegia from SCI presented with sepsis secondary to baclofen pump and urinary tract infections. Read More

Top Spinal Cord Inj Rehabil 2017 ;23(3):207-217

The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.

Injury to the spinal cord produces immediate, adaptive inflammatory responses that can exacerbate the initial injury and lead to secondary damage. Thus far, researchers and clinicians have focused on modulating acute inflammation to preserve sensorimotor function. However, this singular approach risks overlooking how chronic inflammation negatively impacts the broader health of persons with a spinal cord injury (SCI). Read More

Top Spinal Cord Inj Rehabil 2017 ;23(1):57-70

The Sexual Health Network, Inc.

Sexuality is an important part of life, and it is necessary for clinicians to have a specific format in which to address sexual issues with their patients. A systematic approach to working with patients with spinal cord injury (SCI) to improve their sexual functioning and response is presented. Nonjudgmental communication about sexual concerns is followed by a detailed pre- and postinjury medical, psychosocial, and sexual history. Read More

Top Spinal Cord Inj Rehabil 2017 ;23(1):11-19

International Collaboration On Repair Discoveries, Vancouver, BC, Canada.

Spinal cord injury (SCI) may profoundly impact autonomic function producing a variable degree of dysfunction in cardiovascular, bronchopulmonary, sweating, bladder, bowel, and sexual function. The cardiovascular system is crucially important for sexual function, as it is responsible for blood flow shifts to cavernous and musculoskeletal tissue during sexual activity. This system is prone to 3 main abnormalities after SCI including low resting blood pressure (LRBP), orthostatic hypotension (OH), and autonomic dysreflexia (AD), all of which have important effects on sexual function. Read More

Spinal Cord 2018 06 20;56(6):528-537. Epub 2017 Dec 20.

International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, BC, Canada.

Study Design: Systematic review.

Objectives: A spinal cord injury (SCI) commonly results in alterations of cardiovascular physiology. In order to investigate such alterations, the cold pressor test (CPT) has been used as an established challenge test. Read More

Am J Phys Med Rehabil 2018 Jan;97(1):1-6

From the Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea (JAY, YBS, MJS); and Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea (MSK, H-YK).

Objective: The aims of the study were to observe cardiovascular responses during video urodynamic studies and to identify correlations between autonomic dysreflexia events and video urodynamic study findings in spinal cord injuries.

Design: Thirty-four persons with spinal cord injury were enrolled and investigated using continuous cardiovascular monitoring during video urodynamic studies. Associations between cardiovascular responses and video study variables were analyzed. Read More

J Neurotrauma 2018 May 9;35(9):1091-1105. Epub 2018 Feb 9.

1 Department of Biomedical Physiology and Kinesiology, Simon Fraser University , Burnaby, British Columbia, Canada .

Autonomic dysfunction is common in individuals with spinal cord injury (SCI) and leads to numerous abnormalities, including profound cardiovascular and bowel dysfunction. In those with high-level lesions, bowel management is a common trigger for autonomic dysreflexia (AD; hypertension provoked by sensory stimuli below the injury level). Improving bowel care is integral for enhancing quality of life (QoL). Read More

Biomed Res Int 2017 26;2017:2027594. Epub 2017 Oct 26.

Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan, Jeonbuk 54538, Republic of Korea.

Objective: To investigate the prevalence of autonomic dysreflexia (AD) using ambulatory blood pressure monitoring (ABPM) and the autonomic dysfunction following spinal cord injury (ADFSCI) questionnaire in patients with spinal cord injury (SCI) above T6.

Methods: Twenty-eight patients diagnosed with SCI above T6 were enrolled. ABPM and ADFSCI were utilized to assess AD. Read More

J Neurotrauma 2018 Mar 29;35(6):842-853. Epub 2018 Jan 29.

1 Department of Physiology, University of Kentucky , Lexington, Kentucky.

Autonomic dysreflexia (AD) is a potentially life-threatening syndrome in individuals with spinal cord injury (SCI) above the T6 spinal level that is characterized by episodic hypertension in response to noxious stimuli below the lesion. Maladaptive intraspinal plasticity is thought to contribute to the temporal development of AD, and experimental approaches that reduce such plasticity mitigate the severity of AD. The mammalian target of rapamycin (mTOR) has gained interest as a mediator of plasticity, regeneration, and nociceptor hypersensitivity in the injured spinal cord. Read More

J Neurotrauma 2018 Feb 21;35(3):560-572. Epub 2017 Dec 21.

Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine , Miami, Florida.

Prolonged electrical stimulation of the hindbrain's nucleus raphe magnus (NRM) or of its major midbrain input region, the periaqueductal gray (PAG), was previously found in rats to promote recovery from sensory-motor and histological deficits of acute thoracic spinal cord injury (SCI). Here, some visceral deficits of acute and chronic midline cervical (C5) contusion are similarly examined. Cranially implanted wireless stimulators delivered intermittent 8 Hz, 30-70 μA cathodal pulse trains to a brainstem microelectrode. Read More

J Neurotrauma 2018 Feb 2;35(3):573-581. Epub 2018 Jan 2.

1 International Collaboration on Repair Discoveries (ICORD), University of British Columbia , Vancouver, British Columbia, Canada .

We aimed to create a clinically relevant pre-clinical model of transient hypertension, and then evaluate the pathophysiological cerebrovascular processes resulting from this novel stimulus, which has recently been epidemiologically linked to cerebrovascular disease. We first developed a clinically relevant model of transient hypertension, secondary to induced autonomic dysreflexia after spinal cord injury and demonstrated that in both patients and rats, this stimulus leads to drastic acute cerebral hyperperfusion. For this, iatrogenic urodynamic filling/penile vibrostimulation was completed while measuring beat-by-beat blood pressure and cerebral blood flow (CBF) in patients. Read More

Int Med Case Rep J 2017 2;10:361-365. Epub 2017 Nov 2.

Regional Spinal Injuries Centre.

Background: To identify areas for improvement, the National Health Service in England mandates the review of case reports of patients who have died, which should be translated into improved care for other patients.

Case Report: A 49-year-old Caucasian man sustained C-7 tetraplegia in a motorcycle accident in 1992. In 2009, he developed seizures and collapsed in the lavatory on a number of occasions during manual self-evacuation of his bowel. Read More

Neural Regen Res 2017 Sep;12(9):1390-1400

Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, USA.

Autonomic dysreflexia (AD) is a serious cardiovascular disorder in patients with spinal cord injury (SCI). The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons (SPNs) caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes. Read More

Auton Neurosci 2018 01 22;209:1-3. Epub 2017 Sep 22.

Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02134, United States; Cardiovascular Research Laboratory, Spaulding Hospital Cambridge, Cambridge, MA 02138, United States. Electronic address:

Cureus 2017 Jul 25;9(7):e1513. Epub 2017 Jul 25.

Department of Innovation in Medical Education, University of Ottawa.

This case is one of an eight-case multidisciplinary curriculum designed and implemented at the University of Ottawa by simulation educators with specialty training in obstetrics and gynecology (ob/gyn) and anesthesiology. Consultation with a nurse educator maintained quality and relevance of objectives for nursing participants. The curriculum was prepared to train ob/gyn and anesthesiology residents and nurses to hone crisis resource management skills and to recognize and manage rare/critical medical events in an obstetrical setting. Read More