Turkish Journal of Physical Medicine and Rehabilitation
Refractory Orthostatic Hypotension in a Patient with an Injured Cervical Spinal Cord
Bahar DERNEK 1 ,Aydan ORAL 1 ,Resa AYDIN 1 ,Nalan ÇAPAN 1 ,Sina ESMAEİLZADEH 1
1 İstanbul Üniversitesi İstanbul Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İstanbul, Türkiye DOI : 10.5152/tftrd.2015.91979 Refractory orthostatic hypotension may be seen in patients with cervical and upper thoracic spinal cord injury due to the diffuse destruction of the sympathetic innervation of the body despite the preservation of parasympathetic cranial innervation that results in an increased parasympathetic system influence that may not be balanced by disordered sympathetic activity. Pharmacological treatments including mineralocorticoids and adrenergic agents as well as non-pharmacological approaches such as compression using abdominal pads may be treatment options for this condition. The results of mineralocorticoid treatment in conjunction with electrical stimulation application to quadriceps and tibialis anterior muscles are discussed in a 21-year-old male patient who suffered from refractory orthostatic hypotension following a 5th cervical vertebra compression fracture in this case presentation. Additionally, other treatment strategies in orthostatic hypotension are elaborated. Keywords : Spinal cord injury, orthostatic hypotension, treatment