Farnaz Khalighinejad1, Samuel Lee1, Janet Tamai1, Paul Wright1
1Nuvance Health Medical Center
Objective:
To present a case of complete resolution of autonomic dysreflexia (AD) following surgical intervention for cervical spinal stenosis.
Background:
Autonomic dysreflexia is typically associated with high-level spinal cord injuries and is characterized by increased sympathetic nervous system activity, resulting in symptoms such as hypertension, tachycardia, reflex bradycardia, sweating, and dizziness. Although rare, degenerative spinal stenosis can also lead to AD by disrupting sympathetic preganglionic neurons below the level of the stenosis, causing exaggerated visceral responses. This case highlights the resolution of AD following surgical treatment for cervical stenosis.
Results:
A 36-year-old woman with no significant medical history presented with a two-year history of worsening neck pain and bilateral upper extremity discomfort. She initially pursued conservative management, including physical therapy, acupuncture, chiropractic care, and over-the-counter medications, with minimal relief. An MRI of the cervical spine showed bulging discs at C5-6 and C6-7, without evidence of cord compression.
As her condition progressed, she developed new-onset hand weakness, difficulty with fine motor tasks, and autonomic symptoms such as blood pressure and heart rate fluctuations, dizziness, and excessive sweating. Cardiology, endocrinology, and neurology evaluations were largely unremarkable, except for cervical stenosis. Follow-up MRI studies demonstrated worsening stenosis, with a large herniated disc at C6-7 causing severe stenosis and a smaller disc protrusion at C5-6.
She underwent a successful double disc replacement at C5-6 and C6-7. Postoperatively, she experienced immediate improvement in motor strength and balance, with a complete resolution of her autonomic dysreflexia symptoms.
Conclusions:
This case underscores the potential link between cervical spinal stenosis and autonomic dysfunction. The resolution of both motor and autonomic symptoms following surgical intervention suggests that cervical stenosis may disrupt sympathetic neuronal regulation, contributing to the development of AD. Cervical stenosis should be considered a differential diagnosis in patients presenting with AD, particularly after excluding other endocrine, cardiac, and neurologic causes.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.