Context: Episodic attacks of autonomic dysreflexia (AD) are regularly experienced by patients with a spinal cord injury (SCI) on T6 or higher levels. The episodes can result in a pounding headache, flushing, blurred vision, anxiety, a stroke, posturing, hyperthermia, retinal bleeding, seizures, myocardial ischemia, cardiac arrhythmias, and death. The observed associated bradycardia is explained as a baroreceptor reflex response to the high blood pressure. Intrathecal baclofen (ITB) has been used to treat chronic AD. This case highlights the occurrence of intractable AD after removal of the ITB delivery system because of a pump pocket infection. We describe the benefit of ITB as an emergency treatment for intractable AD.

Findings: A 53-year-old male suffered from spasticity and AD after a C5 ASI B SCI in 2002 was successfully treated with ITB for 14 years. He developed Staphylococcus aureus and Pseudomonas aeruginosa cellulitis at the orifice of his suprapubic catheter, which caused an abscess in the pump pocket. To prevent a withdrawal syndrome, the medication was reduced in three steps of 25%, and the pump was explanted. Postoperatively, he experienced severe AD and was treated with clonazepam, clonidine, and urapidil. The next day, the severely fluctuating blood pressure and pulse rate were no longer controllable with the medication. At L2-3, a temporary external intrathecal catheter for reinitiating ITB was inserted. With this treatment, the AD and the spasticity symptoms could be controlled.

Conclusion/Clinical Relevance: The case demonstrated that refractory AD could be managed with ITB in an emergency.

背景： T6 或更高水平的脊髓损伤 (SCI) 患者经常经历自主神经反射异常 (AD) 的发作性发作。发作可导致剧烈头痛、脸红、视力模糊、焦虑、中风、姿势、体温过高、视网膜出血、癫痫发作、心肌缺血、心律失常和死亡。观察到的相关心动过缓被解释为对高血压的压力感受器反射反应。鞘内注射巴氯芬 (ITB) 已被用于治疗慢性 AD。该病例突出了由于泵袋感染而移除 ITB 输送系统后发生顽固性 AD。我们描述了 ITB 作为顽固性 AD 紧急治疗的好处。

结果：一名 53 岁男性在 2002 年 C5 ASI B SCI 成功治疗 ITB 后患有痉挛和 AD 14 年。他在耻骨上导管口感染了金黄色葡萄球菌和铜绿假单胞菌蜂窝织炎，导致泵袋出现脓肿。为了防止戒断综合征，药物分三步减少 25%，并取出泵。术后，他经历了严重的 AD，并接受了氯硝西泮、可乐定和乌拉地尔治疗。第二天，剧烈波动的血压和脉搏不再能用药物控制。在 L2-3 处，插入了用于重新启动 ITB 的临时外部鞘内导管。通过这种治疗，可以控制 AD 和痉挛症状。

结论/临床相关性：该病例表明，在紧急情况下可以用 ITB 管理难治性 AD。