(Kiosk 3) Intractable Autonomic Dysreflexia in a Patient with Postural Orthostatic Tachycardia Syndrome (POTS) and the Impact in Inpatient Rehabilitation: A Case Report

Case Diagnosis: Intractable Autonomic Dysreflexia in a patient with Postural Orthostatic Tachycardia Syndrome (POTS)

Case Description or Program Description: A 45 year old Caucasian female with Postural Orthostatic Tachycardia Syndrome (POTS), C5 incomplete quadriplegia, and chronic urinary tract infections was admitted to an outside hospital for concern of sepsis from UTI causing palpitations and diaphoresis. It was initially thought her dysautonomic symptoms were attributed to Autonomic Dysreflexia. She was treated with antibiotics and was medically stable for discharge to acute rehabilitation. She continued having severe hypertension, tachycardia, spasms and headaches and workup including MRI spine/brain, CT Abdomen/Pelvis, metanephrines/catecholamine and infection studies were negative. These co-morbidities were so severe that it limited the amount of time patient could leave her bed leaving her functionally impaired.

Setting: Inpatient Rehabilitation.

Assessment/Results: POTS syndrome is a condition causing tachycardia when transitioning from sitting or lying down to standing up. The body cannot keep the blood pressure steady and stable. In our patient’s case, she would have tachycardia followed by elevation of blood pressure rather than a decrease. This can be seen in about 20% of cases with POTS. This syndrome is seen in about 1-3 million Americans predominantly affecting adolescent or young adult women.

Discussion (relevance): Due to her incomplete quadriplegia, the patient presented with intractable symptomatic Autonomic Dysreflexia triggered by bladder irritation/overdistension and pain which was further aggravated by POTS symptoms with every out of bed attempt. She underwent a comprehensive inpatient rehabilitation program including intensive telemetry monitoring, medical therapy, and peer support. This allowed our multidisciplinary team to participate with her in a medically stable environment to improve her overall functional ability.

Conclusions: Combined with recurrent Autonomic Dysreflexia, quality of function can be severely debilitating and economically devastating. This case report focuses on the importance of a multidisciplinary team approach within a tertiary care center which provided this young woman with the opportunity to enhance her functional ability and quality of life which would not have been possible in a different setting.