Among other autonomic dysfunctions complicating acute spinal cord injury, deep hypothermia is rare but may induce serious cardiovascular complications. There are few pharmacological options to influence hypothermia. She had been admitted to the hospital two months before for an acute L4-L5 infectious spondylodiscitis without any initial neurological deficit.
After surgery for epidural abscess drainage, she became paraplegic due to spinal cord infarction from C7 to T6 levels in the upper territory of the anterior spinal artery. Common causes of hypothermia drugs, hypothyroidism, etc. A definitive pacemaker had to be inserted, but hypotension persisted. This case report illustrates that patients with incomplete spinal cord injury may present with delayed and deep hypothermia leading to serious cardiovascular complications.
Progesterone could be able to influence positively central and Dominic di natale wife sexual dysfunction thermal regulation. Autonomic dysfunction complicating spinal cord injury SCI may consist in cardiac arrhythmias, orthostatic hypotension, and thermoregulatory disturbances. Critically low core temperature was significantly improved by oral progesterone. A year-old woman with a previous medical history of hyperthyroidism and chronic myeloid leukaemia developed an acute L4-L5 infectious spondylodiscitis a few days after having received dental care.
She complained from low back pain but had no neurological deficit. The initial magnetic resonance imaging MRI Figure 1 a demonstrated a necroticocystic lumbar spondylodiscitis complicated by huge epidural abscess with diffuse inflammation of adjacent meninges. Lumbar spine MR work-up at admission.
Spondylodiscitis at L4-L5 level arrow with necroticocystic intersomatic abscess and strong enhancement of the adjacent bone marrow. Anterior epidural abscess is well seen asterisk impinging on posteriorly displaced thecal sac. Note intense enhancement of the dura arrow.
The patient underwent surgical exploration and resection of the L4-L5 intervertebral disc. Intraoperative CSF culture returned positive for Prevotella loescheii. In the immediate follow-up of the surgical procedure, the patient was found paraplegic with also anaesthesia at a T6-T7 level. A follow-up spinal cord MRI Figure 1 b Dominic di natale wife sexual dysfunction the onset of a spinal cord infarction from C7 to T6 in the upper territory of the anterior spinal artery featured by a sharply delineated hypersignal intensity within involved areas on T2-weighted images Figure 2.
While staying in the rehabilitation unit, the patient developed atrial fibrillation that was treated by sotalol. Echocardiography revealed a marked and diffuse depression of the left ventricular function. There was also a recent worsening of renal function with oliguria. The patient even presented a transient episode of asystole. With the suspicion of drug accumulation, sotalol therapy was stopped.
Hemodynamic conditions gradually improved after dobutamine infusion and the patient returned to the rehabilitation unit. She was readmitted in the ICU one month later with asystole and was again successfully resuscitated.
Hypothermia was confirmed by the recording of the core temperature by a central venous thermodilution catheter. The decrease in body temperature was never followed by shivering, but well by an alteration of consciousness.
Pharmacological causes of drug-induced hypothermia could be excluded. Noteworthily, a significant weight loss and skeletal muscle wasting were noted over the last weeks. Thyroid function tests were within the normal range. Brain MRI was unremarkable. External rewarming techniques blankets, increase of room ambient temperature remained unsuccessful. Due to the recurrence of extreme bradycardia with episodes of sinus block, a definitive pacemaker had to be inserted; after that a coronary angiography had failed to reveal coronary lesions.
Sudden hypotensive episodes still occurred and norepinephrine infusion needed to be continuously adapted. Hypotension occurred frequently during the night shift, at a time that core temperature was lower.
Progesterone transient withdrawal for two days was followed by a new drop in Dominic di natale wife sexual dysfunction temperature. Dominic di natale wife sexual dysfunction the start of progesterone, there was no clear evidence for orthostatism when the patient was mobilized from her bed to a chair during the day shift. The neurological status of the patient also significantly improved and was ultimately discharged from the ICU.
At follow-up, two months later, left ventricular function had also improved at echocardiography. Follow-up MR examination of the cervicodorsal segments. Core temperature recorded from a central venous catheter twice a day 4: Abnormal thermal regulation in SCI is mainly due to reduced sensory input to temperature regulation centres and to the loss of sympathetic control of temperature and sweat control below the level of injury [ 3 Dominic di natale wife sexual dysfunction 7 ].
Hypothermia produces effects on many organ systems, including hemodynamic instability with arrhythmias and depression of myocardial contractility [ 2 ].
In a study enrolling patients with incomplete SCI, core and body temperatures measured by digital infrared thermographic imaging were analysed among three groups: While there was no statistically significant difference in the comparison of core temperatures among the three groups, patients with upper SCI had lower skin temperature than the patients with lower SCI and control group.
This confirms the role of peripheral receptors in body temperature control in patients with upper SCI [ 5 ]. Body surface temperature is affected by diverse factors but is mainly controlled by the sympathetic nervous system.
Cold exposure stimulates cold-sensitive receptors present in the skin, leading to prompt vasoconstriction that preserves heat dissipation and stimulates shivering reaction that increases basal metabolic rate and heat production. Investigations in paraplegic patients have that these patients will start to shiver to increase heat production at a lower central temperature than control subjects [ 56 ]. Otherwise, a reduced peripheral vasoconstrictive response to adrenergic stimuli is likely to contribute to orthostatic tolerance and to an increase in heat dissipation.
Whether this concept could be applied to reduce orthostatism or heat dissipation from peripheral vasodilation was never investigated in patients with complete or incomplete SCI.
Additionally, progesterone may also tend to shift central regulation of body temperature to higher temperature [ 12 ]. Finally, the influence of progesterone on thermal regulation was rarely investigated in men. Profound hypothermia with extremely serious cardiovascular manifestations may also be encountered in paraplegic patients. In the present observation, the extension of the ischemic medullar injury to a high-level probably explained that a large proportion of the skin was insentient, with an impaired response to changes in cold and hot.
The apparent benefit of progesterone therapy could be ascribed to either a central higher set point or peripheral increase of cutaneous vasoconstriction mechanism, but this has to be confirmed by other observations as prolonged progesterone therapy may also induce side effects.
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Case Rep Neurol Med. Published online Oct 4. Philippe Hantson 1 and Thierry Duprez 2. Author information Article notes Copyright and License information Disclaimer. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Among other autonomic dysfunctions complicating acute spinal cord injury, deep hypothermia is rare but may induce serious cardiovascular complications.
Introduction Autonomic dysfunction complicating spinal cord injury SCI may consist in cardiac arrhythmias, orthostatic hypotension, and thermoregulatory disturbances. Case Presentation A year-old woman with a previous medical history of hyperthyroidism and chronic myeloid leukaemia developed an acute L4-L5 infectious spondylodiscitis a few days after having received dental care. Open in a separate window.
Discussion Abnormal thermal regulation in SCI is mainly due to reduced sensory input to temperature regulation centres and to the loss of sympathetic control of temperature and sweat control below the level of injury [ 3 — Dominic di natale wife sexual dysfunction ].
Conclusion Profound hypothermia with extremely serious cardiovascular manifestations may also be encountered in paraplegic patients. Conflicts of Interest The authors report no conflicts of interest. Cardiovascular complications of spinal cord injury. Systolic and diastolic left ventricular dysfunction due to mild hypothermia.