at a Glance

Hashim Hashim, Prokar Dasgupta

Case Studies

Chapter 10 Case 2: Spinal cord injury

A 22-year-old man has a motorcycle crash and obtains a T4 injury to his spinal cord. He is wheelchair bound and has to strain to pass urine.

  • 1 What is the classification of his injury?

    Correct answer:

    Supra-sacral. Supra-sacral injuries occur between the pons of the brainstem and L5 spinal segment.

  • 2 Name three possible findings in those with suprasacral injuries?

    Correct answer:

    1. Neurogenic detrusor overactivity is often found in those with suprasacral type injuries.
    2. Detrusor–sphincter dysynergia can also be a finding as the patient can experience detrusor overactivity with sphincter spasticity leading to abnormally high bladder pressures.
    3. Autonomic dysreflexia can also occur in suprasacral lesions above the level of T6. If present this is a medical emergency.

  • 3 What is the single most important investigation required to assist with this patient’s management?

    Correct answer:

    Video-urodynamics. This is the best investigation as it permits assessment of both anatomy and function of the lower urinary tract.

  • 4 If the video-urodynamic test confirmed neurogenic detrusor overactivity with detrusor–sphincter dysynergia, how would you treat this patient?

    Correct answer:

    The main aim of treatment is keeping the bladder pressures low. In the first instance this could be done by teaching him intermittent self-catheterisation, as this normalises bladder pressures and avoids the complications of long-term catheterisation.

  • 5 How do you treat autonomic dysreflexia?

    Correct answer:

    Autonomic dysreflexia is a medical emergency and should be identified without delay. Remove the offending stimulus, sit the patient up and administer nifedipine.

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