Second, women with lesions above T 5-T6 are at risk for autonomic dysrlexia. With this, stimuli from structures innervated below the level of the spinal lesion lead to massive, disordered sympathetic stimulation. Abrupt catecholamine release can cause vasoconstriction with severe hypertension and symptoms that include throbbing headaches, facial flushing, sweating, bradycardia, tachycardia, arrhythmias, and respiratory distress . Dysrelexia can be precipitated by various stimuli. hese include urethral catheterization, bladder distention from urinary retention, rectal or cervical stretch during digital examinations, uterine contractions and cervical dilation, or any manipulation of other pelvic structures (American College of Obstetricians and Gynecologists, 2016; Krassioukov, 2009). In one report, 12 of 15 women at risk for autonomic dysreflexia sufered at least one episode during pregnancy (Westgren, 1993).
Because uterine contractions are not afected by spinal cord lesions, labor is usually easy-even precipitous, and comparatively painless. If the lesion is below T12' uterine contractions are felt normally. For lesions above T 2, the risk of out-of 1rhospital delivery is substantial and can be minimized by teaching women to palpate for uterine contractions. This is especially important because up to 20 percent of women deliver preterm (Westgren, 1993). Some recommend tocodynamometry and weekly cervical examinations beginning at 28 to 30 weeks. Another reasonable option that we frequently employ at Park land Hospital is elective hospitalization after 36 to 37 weeks' gestation (Hughes, 1991).
Spinal or epidural analgesia extending to TIO prevents autonomic dysrelexia and should be instituted at the start of labor. If there are severe symptoms before epidural placement, steps are taken to abolish the provoking stimulus. A parenteral antihypertensive agent such as hydralazine or labetalol is given. Labor and vaginal delivery with epidural or spinal analgesia is preferable and will minimize autonomic dysrelexia (Kuczkowski, 2006). Operative vaginal delivery is frequently necessary.
Also known as pseudotumor cerebri, this disorder is typified by increased intracranial pressure without hydrocephalus. The cause is unknown, but it may result from overproduction or under absorption of cerebrospinal luid (CSF). Symptoms include headache in at least 90 percent of cases, visual disturbances such as loss of a visual field or central visual acuity in 70 percent, and commonly occurring papilledema that may be sight-threatening (Evans, 2000; Heaney, 2010). Other complaints are stif neck, back pain, pulsatile tinnitus, and cranial nerve palsies.
he syndrome is oten found in young women and is prevalent in those who are obese, who recently gained weight, or both (Fraser, 201r1). Along with symptoms, other criteria for diagnosis include elevated intracranial pressurer> 25 em H20, normal CSF composition, normal cranial CT or MR imaging indings, papilledema, and no evidence for systemic disease. If papilledema is not present, other criteria are required (Friedman, 2013).
Idiopathic intracranial hypertension is usually self-limited.
Visual defects can be prevented by lowering the CSF pressure, and agents include acetazolamide to reduce fluid production, furosemide, or topiramate. Corticosteroids are now rarely used. Surgical intervention is occasionally necessary and is accomplished by either lumboperitoneal shunting of spinal fluid or optic nerve sheath fenestration.