1112 - Case of Refractory Autonomic Dysreflexia in Patient with C7 AIS B SCI

Autonomic Dysreflexia (AD) in patient with C7 ASIA Impairment Scale (AIS) B Spinal Cord Injury (SCI)

Case Description: A 68-year-old male patient with a history of C7 AIS B SCI and bladder spasms presented to outpatient rehabilitation clinic following episodes of persistent AD with associated urinary leakage despite adequate clean intermittent catheterization (CIC) program performed as frequently as every hour while awake. He tracked blood pressure and experienced multiple daily episodes consistent with AD that improved with CIC yet persisted regardless of CIC frequency. He received high-dose Mirabegron and OnabotulinumtoxinA injections to the bladder with no significant change in frequency of episodes. Initially, he was resistant to considering indwelling foley and felt that given the frequency of CIC it would not be of significant benefit. A hospital encounter to evaluate possible causes of AD, including CT panscan, did not reveal clear cause. He eventually underwent placement of indwelling foley with improvement of episodes and plans to undergo placement of suprapubic catheter.

Discussions: Frequent CIC has been an important part of preventing episodes of AD by avoiding overdistention of the bladder. OnabotulinumtoxinA injections has also been evidenced to reduce episodes of AD in the setting of neurogenic detrusor overactivity. Prior studies have shown more urological complications with indwelling catheter, and data reports are variable regarding patient-reported quality of life with indwelling catheter. This study demonstrates the need for indwelling foley when CIC and bladder botulinum toxin fail to decrease episodes of AD frequency.

Conclusions:

This case illustrates the challenges of managing AD associated with SCI and complex urologic symptoms refractory to frequent CIC and botulinum toxin to the bladder, as well as the benefit of placement of indwelling foley to better assess for alternative causes as needed.