Management of Hypotension and Bradycardia Caused by Spinal Cord Injury. The Usefulness of Midodrine and Methylxanthines

Spinal cord injury is a devastating chronic condition resulting in temporary or permanent motor,sensory or autonomic dysfunction of the cord. The manifestation of spinal cord injury based onthe severity and involved areas could be different. Numerous studies have demonstrated thatbradycardia, hypotension, and orthostatic hypotension are present insignificant number ofpatients after spinal cord injury which peaks at 4th day of injury. Although vasopressors arecommon drugs that have been used to restore blood pressure and heart rate in patients withneurogenic shock, there is limited data regarding pharmacologic management of bradycardia andhypotension after spinal cord injury. Midodrine is a potent vasopressor approved for themanagement of symptomatic orthostatic hypotension. Theophylline and aminophylline aremethylxanthine derivatives. There are very few case reports concerning the use of midodrine andmethylxanthines for treatment of hypotension in patients with spinal cord injury. In this casereport and review of the articles we report a 45 year old woman with a diagnosis of spinal cordinjury who was successfully managed with midodrine and aminophylline and then we reviewcurrent case reports. Based on our case report and other available data, midodrine as well asmethylxanthines can be suggested as therapeutic options for managing symptoms in spinal cordinjury patients.