Surgery to treat autonomic dysreflexia due to cubital tunnel syndrome in cervical spinal cord injury: a case report

INTRODUCTION: Autonomic dysreflexia (AD) is a potentially fatal syndrome in people with spinal cord injury (SCI) marked by episodic hypertension with flushing, diaphoresis, and bradycardia. Common etiologies include bladder distension and bowel impaction. Compressive neuropathies lack attention as a potential precipitant of AD. This report describes an individual with cervical SCI and with recurrent AD treated with ulnar nerve decompression surgery. CASE PRESENTATION: A 74-year-old woman with a remote history of C6 SCI (American Spinal Injury Association Impairment Scale Grade B) presented to clinic with recurrent episodes of AD that had been refractory to standard treatment measures. History and clinical examination were suggestive of ulnar nerve compressive neuropathy at the elbow - cubital tunnel syndrome. The diagnosis was confirmed with electrodiagnostic studies and neuromuscular ultrasound. Treatment with surgery successfully resolved her episodes of AD. DISCUSSION: This case identifies compressive neuropathy as a treatable cause of AD in individuals with cervical SCI. When more common etiologies of AD are excluded, clinicians should consider compressive peripheral neuropathies as potential causes of AD. Surgical decompression may alleviate symptoms of AD in select cases. Further research should investigate the prevalence and optimal management of compressive neuropathy in people with SCI.