2804NRS Case Study: Pathophysiology, Pharmacology and Treatment of SCI

This case study analyzes the case of Susan Kennedy, a 65-year-old woman diagnosed with spinal cord compression due to osteoporotic vertebral fractures at T5-T6, following a fall. The analysis encompasses the patient's symptoms, including upper back pain, bowel movement issues, numbness in legs, and a significantly elevated blood pressure of 210/100 mm/Hg, alongside hyperreflexia. The pathophysiology is explored, linking the fall, spinal cord injury, and the development of autonomic dysreflexia (AD). The study highlights the role of risk factors like old age and the aetiology of the disease, emphasizing the importance of medications for blood pressure reduction and pain management, such as NSAIDs and narcotics. Diagnostic methods like CT scans and MRI are discussed, alongside treatment strategies including ACE inhibitors and pacemakers to stabilize the patient's condition. References to relevant literature support the analysis of the patient's condition and treatment.

Running head: PATHOPHYSIOLOGY AND PHARMACOLOGY
CASE STUDY ANALYSIS
Name of the Student
Name of the University
Author Note

Running head: PATHOPHYSIOLOGY AND PHARMACOLOGY
Concept map
Key
Risk factors
Aetiology
Pathophysiology
Clinical manifestation
Diagnostics
Treatment
Old age (65 years)
Spinal cord injury Bladder filling and excessive
response from the nervous
system
Specific
disc injury
CVD Cutaneous,
proprioceptive
lesion
1. Osteoporotic vertebral fracture at
T6.
2. Hyperreflexia in quadriceps.
3. Numbness in both legs.
4. Autonomic dysrelexia
High blood
pressure
High response to
stimuli
Corticospinal
descending pathway
interruption
Diagnosis
of high
blood
pressure
Nervous system
diagnosis Diagnosis of high
hypertension and
swelling including
numbness
1. CT Scan: Common
diagnostic imaging
process in spine in
patients who are
suffering from spinal
cord injury. This
technique is fast,
accurate and non-
invasive.
2. MRI: Used
for the
evaluation of
accurately
injured spine.
Can assess disc
protrusions.
Damaged nerves can
be diagnosed with CT
scan imaging
procedure.
Rapid painless
process performed by
combining X ray and
computer technology.
A lumbar spine
CT scan has been
found to carry
very few risks.
The contrast dye
used during the
procedure may
cause temporary
kidney damage,
though.
X- Ray imaging-
Spine X ray has been
found to provide
detailed images of
bones of the spines.
Medications for effective blood pressure reduction must be
administered and pacemakers must be used to stabilize the
heartbeat rates. ACE or angiotensin-converting enzyme
inhibitors can be used to prevent the narrowing of blood vessels
which leads to a decrease in blood pressure. To help the patient
in recovering from osteoporotic vertebral fracture observed in
her T5-T6 vertebrae, she must be administered with NSAIDs
and narcotics at low doses.

1PATHOPHYSIOLOGY AND PHARMACOLOGY
The patient, Susan Kennedy has been found to be suffering from an upper back pain
which has increased to a high extent. Susan suffered a fall from an armchair, post to which
she has been experiencing these types of disorders associated with her lower back. Susan has
also been stated to be associated with bowel movement disorders and has also been found to
be associated with numbness in her legs. This condition prevented her from moving her legs
since both of her legs were numb. Her medical records showed a hike in her blood pressure
which resulted in a value of 210/100 mm/Hg. This condition has further been found to be
associated with hyperreflexia in her quadriceps tendons present in both the legs. Susan was
found to have a sharp tenderness over T6 which has been. In the hospital, she was diagnosed
with spinal cord compression which occurred due to osteoporotic vertebral fractures of T5-
T6.
Hyperreflexia has been defined as a condition associated with over-responsive
reflexes or over-reactive reflexes. Several examples have been found to include spastic and
twitching tendencies which have been found to be indicative of upper motor neuron disorders
(Leão & Figueiredo, 2016). This condition has been found to be associated with Susan also
since she felt and uneasiness and problems with her upper back. The patient can be stated to
suffer from a neurological disorder due to a breakage in her spinal cord. Pieces of literature
have been found to suggest the fact that spinal cord fractures lead to neurological disorders in
osteoporotic patients (Chowdary & Gilbertson, 2018). Increase in blood pressure was another
signifying symptom of hyperreflexia. The patient can be stated to suffer from an Automic
dysrelexia or AD which is a condition in which the involuntary nervous system overreacts to
any types of bodily or external stimuli (Leão & Figueiredo, 2016). A dangerous spike in
blood pressure has been proved to be associated with this condition by various literature
pieces (Lee et al., 2016). In this case, it has been observed that the hike in blood pressure has
reached to 210/100 mm Hg which means a 20-49 mm/Hg rise in blood pressure from the

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normal value. Pieces of literature have also suggested that any types of spinal cord injury can
give rise to a condition known as AD as stated before. AD has been found to cause systolic
blood pressure which leads to an increase of blood pressure by 30 mm/Hg (Lee et al., 2016).
In this disorder, it has been observed that there is a spinal reflex associated with an inhibition
of descending feedback. This factor holds the aetiology of the disease. Observations have
also been made on the fact that this condition also couples dangerously with decreased heart
rates which can also cause patient death. Susan has been stated to suffer from a broken spinal
cord due to a fall from her armchair. This was the beginning of hyperreflexia in her which
finally lead to an increase in her blood pressure. In this way, all the risk factors and
aetiological factors associated with the case symptoms can be accumulated to conclude the
presence of a disorder in Susan.
To help the patient in recovering from osteoporotic vertebral fracture observed in her
T5-T6 vertebrae, she must be administered with NSAIDs and narcotics at low doses. These
two drugs have been found to have many roles in patient treatment associated with
osteoporotic compression fractures (Carey & Whelton, 2018). Pain relief has been found of
paramount concern for the treatment of this condition. Now, to help her in recovering from
her condition of hyperreflexia, blood pressure reduction is a must (Qureshi & Asad, 2019).
Medications for effective blood pressure reduction must be administered and pacemakers
must be used to stabilize the heartbeat rates. ACE or angiotensin-converting enzyme
inhibitors can be used to prevent the narrowing of blood vessels which leads to a decrease in
blood pressure. Some of the examples of such medications are Diuretics, Beta-blockers, ACE
inhibitors, Angiotensin II receptor blockers, Alpha-blockers and calcium blocker channels
(Carey & Whelton, 2018). A combination of such medications can be used to reduce blood
pressure. These medications will prevent the occurrence of high blood pressure and will save
the patient from any types of risk associated with cardiovascular disorders. Gradually, the

3PATHOPHYSIOLOGY AND PHARMACOLOGY
patient can be hoped to get recovered from her current condition with a slow recovery from
hyperreflexia associated with her problem with the spinal cord.
References
Carey, R. M., & Whelton, P. K. (2018, March). Prevention, detection, evaluation, and
management of high blood pressure in adults: synopsis of the 2017 American College
of Cardiology/American Heart Association Hypertension Guideline. Annals of
internal medicine, 168(5), 351-358. DOI:
https://annals.org/aim/article-abstract/2670318.
Chowdary, H., & Gilbertson, L. (2018, November). Autonomic Hyperreflexia. In Consults in
Obstetric Anesthesiology (pp. 83-85). Springer, Cham. DOI:
https://link.springer.com/chapter/10.1007/978-3-319-59680-8_21.
Leão, P., & Figueiredo, P. (2016, March). Autonomic hyperreflexia after spinal cord injury
managed successfully with intravenous lidocaine: a case report. Patient safety in
surgery, 10(1), 10. DOI:
https://pssjournal.biomedcentral.com/articles/10.1186/s13037-016-0098-5.
Lee, J. S., Fang, S. Y., Roan, J. N., Jou, I. M., & Lam, C. F. (2016, January). Spinal cord
injury enhances arterial expression and reactivity of α1-adrenergic receptors—
mechanistic investigation into autonomic dysreflexia. The Spine Journal, 16(1), 65-
71. DOI: https://doi.org/10.1016/j.spinee.2015.09.030.
Qureshi, M. A., & Asad, A. (2019, January). Pain Relief After Vertebroplasty For
Osteoporotic And Osteolytic Compression Fractures. Anaesthesia, Pain & Intensive
Care. DOI: https://pssjournal.biomedcentral.com/articles/10.1186/s13037-016-0098-
5.

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