Central nervous system

Autonomic dysreflexia – see above.

A small proportion of patients with traumatic spinal cord injury develop syrinx/syringomyelia resulting in further neurological symptoms/signs. These may develop over many years. Patients may present with symptoms of severe upper extremity pain caused by an expanding cyst. They may report excess perspiration; weakness or excess spasticity. The pain may be very localised to one or other forearm, often similar to compartment syndrome with localised erythema and generalised swelling. A detailed sensory motor assessment will be essential. MR scan examination of the spinal cord before referral to an orthopaedic surgeon/neurosurgeon would be an advantage.

Changes in spasticity may be caused by many unrelated conditions such as urinary infection, anxiety, constipation, piles, toenail infection etc.

Acute confusional state in longstanding paraplegic patients may be related to hyponatraemia from a habit of excessive drinking of water. Chest infection or septicaemia due to urinary tract infection can also result in confusional states.

Restriction of fluid may be adequate treatment.

A confusional state can also be precipitated by sudden withdrawal (accidental) of routine medication such as Baclofen and/or Diazepam.