Case Report
Spinal Cord (2006) 44, 695–696. doi:10.1038/sj.sc.3101907; published online 7 February 2006
Micturition syncope following intermittent catheterisation in a tetraplegic patient
J G Previnaire1 and J M Soler2
- 1Spinal Unit, Centre Calve, Berck, France
- 2Centre Bouffard-Vercelli, Cerbere, France
Correspondence: JG Previnaire, Spinal Unit, Centre Calve, rue du Calvaire, 62600 Berck, France
Abstract
Study design:
Case report.
Objective:
To describe a case of severe hypotension and occasional syncope following intermittent catheterisations in a tetraplegic patient.
Setting:
Department of Spinal Injuries, Berck, France.
Case report:
A 47-year-old man presenting with C7 ASIA B tetraplegia for 9 months, developed episodes of severe hypotension and occasional syncope following intermittent catheterisations. These episodes were observed in the minutes following the catheterisations performed in the sitting position, associating hypotension and bradycardia. He was on intermittent catheterisation, had a history of bladder hyper-reflexia with some episodes of symptomatic urinary tract infections, of mild autonomic dysreflexia (headache, sweating) on high bladder distension, of mild orthostatic hypotension, and of reactional depression to the trauma, treated with fluoxetine hydrochloride (Prozac®).
Results:
The progressive removal of the fluoxetine hydrochloride (Prozac®) led to disappearance of the syncope 1 week later. Mild hypotension after catheterisations still persisted though, but completely disappeared a few months later after further management of bladder hyper-reflexia with botulinum-A toxin injections into the detrusor.
Conclusion:
In spinal cord injury patients at risk of micturition syncope, care should be taken to achieve a gradual decrease in bladder volume, to control bladder hyper-reflexia and to avoid any medications with orthostatic hypotension's side effects.
Keywords:
spinal cord injury, hypotension, micturition syncope, autonomic dysreflexia, catheters
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