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Autonomic dysreflexia pathophysiology

Pathophysiology of autonomic dysreflexia: long-term

  1. Pathophysiology of autonomic dysreflexia: long-term treatment with terazosin in adult and paediatric spinal cord injury patients manifesting recurrent dysreflexic episodes Spinal Cord . 1998 Nov;36(11):761-70. doi: 10.1038/sj.sc.3100680
  2. What is autonomic dysreflexia? Autonomic dysreflexia (AD) is a potentially life-threatening medical emergency that affects people with spinal cord injuries at the T6 level or higher. Although rare, some people with T7 and T8 injuries can develop AD. For most people, AD can be easily treated as well as prevented
  3. Autonomic Dysreflexia (AD) is a condition that commonly affects people with spinal cord injury (SCI) above the level of T6. 1 It is defined as a sudden systolic blood pressure increase by more than 20-40 mmHg. 2 90% of peopl
  4. The first episode of autonomic dysreflexia (AD), also known as autonomic hyperreflexia, usually occurs after the phase of spinal shock and the return of reflex responsiveness (usually hours to weeks following the injury, Comarr and Eltorai). The potential to experience this exaggerated response to noxious stimuli persists throughout the individual's lifetime. AD is caused by a noxious stimulus below the level of the lesion
  5. Alternatively termed autonomic dysreflexia, this condition results from chronic disruption of efferent impulses down the spinal cord, as in spinal cord trauma or tumor impingement.22 Autonomic hyperreflexia is uncommon if the level of disruption is below T5

Autonomic dysreflexia - Reeve Foundatio

Development of autonomic dysreflexia after spinal cord injury is associated with a lack of serotonergic axons in the intermediolateral cell column. J Neurotrauma . 2010 Oct. 27(10):1805-18. What Is Autonomic Dysreflexia? Autonomic dysreflexia is a serious medical problem that can happen if you've injured your spinal cord in your upper back. It makes your blood pressure dangerously..

Pathophysiology of Autonomic Dysreflexia First, we need to review the autonomic nervous system: The autonomic nervous system controls the involuntary functions of the body, and it's divided into two branches Autonomic Dysreflexia Complications It is a dangerous spinal condition characterized by sudden increase in the blood pressure level due to over-activity of the ANS or Autonomic Nervous System. Individuals with injury levels more than T-6 are more likely to develop this condition PAThOPhySIOLOGy Autonomic dysreflexia results from widespread reflex activity of the sympathetic nervous system below the level of injury, triggered by an ascending sensory (usually noxious) stimulus. Following stimulation, overactivity of sympathetic ganglia remains uncontrolled due to isolatio

Autonomic Dysreflexia - PubMe

Topic Overview. Autonomic dysreflexia is a syndrome in which there is a sudden onset of excessively high blood pressure.It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above).. Be prepared to call your spinal cord injury therapist, 911, or other emergency services if you or the person with the spinal cord injury (SCI) has the. sional care. If you develop warning signs of autonomic dysreflexia, contact a physician or other appropriate health-care professional as soon as possible. This Guide has been prepared based on scientific and professional information known about autonomic dysreflexia, its causes, and treatment, in 1997. It is recÂ

Autonomic dysreflexia (AD), also previously known as mass reflex, is a potential medical emergency classically characterized by uncontrolled hypertension and bradycardia, although tachycardia is known to commonly occur. AD occurs most often in individuals with spinal cord injuries with lesions at or above the T6 spinal cord level, although it has been reported in patients with lesions as low. Pathophysiology Autonomic dysreflexia is triggered when a painful stimulus occurs below the level of the SCI. The response is mediated through the nervous system, which includes the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS consists of the brain and spinal cord with their nerves and end organs that control. Spinal Cord Autonomic Dysreflexia. Autonomic dysreflexia is a disorder of autonomic nervous system dysregulation that occurs in patients with a spinal cord injury and that can result in life-threatening hypertension. It occurs in 20% to 70% of patients, 1 month to 1 year after spinal cord injury. Cord injury is usually above the T6 level, with. Autonomic Dysreflexia after Spinal Cord Injury: Systemic Pathophysiology and Methods of Management Khalid C. Eldahana,b and Alexander G. Rabchevskya,b,* aDepartment of Physiology, University of Kentucky, Lexington, KY 40536, United States bSpinal Cord and Brain Injury Research Center, University of Kentucky, Lexington, KY 40536, United States Abstract. Briefly, autonomic dysreflexia develops in individuals with a neurologic level of spinal cord injury at or above the sixth thoracic vertebral level (T6). Autonomic dysreflexia causes an imbalanced..

Autonomic Dysreflexia - an overview ScienceDirect Topic

  1. Autonomic dysreflexia is a condition characterized by transient bursts of massive sympathetic discharges that result in dangerous episodic hypertension in response to a noxious stimulus below the level of injury 20). Clinically, autonomic dysreflexia is indicated when systolic blood pressure rises above baseline by at least 20 mmHg
  2. Autonomic dysreflexia (AD) is a condition of uncontrolled sympathetic response secondary to a precipitant, that generally occurs in patients with injury to the spinal cord at levels of T6 and above. AD is important on two accounts
  3. Vaidyanathan, S., Soni, B., Sett, P. et al. Pathophysiology of autonomic dysreflexia: long-term treatment with terazosin in adult and paediatric spinal cord injury patients manifesting recurrent.

What is autonomic dysreflexia (AD)? Autonomic dysreflexia (AD) is a condition in which your involuntary nervous system overreacts to external or bodily stimuli. It's also known as autonomic.. and Autonomic Dysreflexia panel chair and members of the AD guideline development panel wish to express special appreciation to the individuals and professional organizations who are members of the Consortium for Spinal Cord Medicine and to the expert health-care providers, researchers, and other profes-sionals who critiqued the draft documents Vasodilation above the level of the cord injury causes facial flushing, headache, nasal congestion, blurred vision, nausea and diaphoresis. Inhibition causes bradycardia. Pilomotor spasm (goose flesh) can also occur. Horner's is a less common finding that can occur with autonomic dysreflexia. It is caused by dysruption of the sympathetic pathways To describe the pathophysiology of autonomic dysreflexia and other common autonomic dysfunctions following SCI. 2. To identify the clinical aspects of autonomic dysreflexia and other common types of autonomic dysfunction following SCI. 3. To discuss the new autonomic dysreflexia and other common autonomic dysfunction clinical practice guideline What is Autonomic Dysreflexia? Autonomic Dysreflexia (AD), sometimes referred to as Autonomic Hyperreflexia, is a potentially life-threatening medical condition that many people with spinal cord injury (SCI) experience when there is a pain or discomfort below their level of injury, even if the pain or discomfort cannot be felt. Am I at risk for AD

What is the pathophysiology of spinal cord injury leading

Autonomic Dysreflexia (AD), also known as autonomic hyperreflexia, is an emergency situation. It is an abnormal response which occurs when your body is experiencing pain or discomfort below the level of your spinal cord injury (SCI). Because the pain or discomfort message does not get to the brain because of the spinal cord injury, the body's. Autonomic dysreflexia: a medical emergency J Bycroft, I S Shergill, E A L Choong, N Arya, P J R Shah Postgrad Med J 2005;81:232-235. doi: 10.1136/pgmj.2004.02446 Pathophysiology of Autonomic dysreflexia. In both normal and SCI patients, noxious stimulation of peripheral sensory receptors (i.e., bladder distention) will activate afferent pathways to produce a sympathetic response. The sympathetic outflow stimulates peripheral vasoconstriction, thus elevating arterial blood pressure Many health care professionals are unfamiliar with either symptoms or causes of autonomic dysreflexia or its appropriate management. Patient and family education about Autonomic dysreflexia is the most important. Key Words: Autonomic dysreflexia, nursing diagnosis, spinal cord injury. Introduction Autonomic dysreflexia (AD) is a common acut Definition and Pathophysiology of Autonomic Dysreflexia. Although the definition for AD has evolved over time, it is currently defined by The International Standards for Documentation of Remaining Autonomic Function after SCI [1•].AD is a constellation of signs and/or symptoms in individuals with SCI at, and usually above, T6 in response to noxious or non-noxious stimuli below the level of.

Pathophysiology. Autonomic dysreflexia occurs in 48-90% of patients with spinal cord injury (SCI) above the splanchnic sympathetic outflow. It usually manifests 3-4 months after SCI, but it may occur as early as the fourth day and as late as 12 years postinjury. A lesion at or above the T6 level disconnects the caudal spinal region. The most common cause of autonomic dysreflexia (AD) is spinal cord injury. The nervous system of people with AD over-responds to the types of stimulation that do not bother healthy people. Other causes include: Guillain-Barré syndrome (disorder in which the body's immune system mistakenly attacks part of the nervous system

Autonomic Dysreflexia Article - StatPearl

Autonomic Dysreflexia - Symptoms, Causes, Treatment

Autonomic dysreflexia definition. Autonomic dysreflexia is a very dangerous condition faced by individual suffering from quadriplegia . To remain safe from it one should have a very thorough understanding of its symptoms, causes and treatment. In below lines you will read in detail about all that Autonomic Dysreflexia. 1)Define Autonomic Dysreflexia (AD) in simple terms 2)Describe the pathophysiology 3)List the life threatening complications 4)List the most common precipitants 5)List signs and symptoms. 6)Formulate an acute management plan using both non-pharmacologic and pharmacologic treatment options. Non-pharmacologic Treatment. What is autonomic dysreflexia? Autonomic dysreflexia (AD) is a condition that causes sudden, extremely high blood pressure. AD is most common in people with a spinal cord injury in the neck or upper back. What causes AD? Ask your healthcare provider about these and other causes of AD: Overfull bladder or urinary tract infectio bladder care for prevention of autonomic dysreflexia in the future. DISCUSSION Pathophysiology Also known as autonomic hyperreflexia, AD occurs as a result of an overactive autonomic nervous system. Noxious stimuli below the level of the spinal cord injury stimulate afferent impulses which trigger reflex sympathetic activity. This results in.

Autonomic Dysreflexia:Autonomic Dysreflexia is a clinical emergency in individuals with spinal cord injury (www.scireproject.com).Autonomic Dysreflexia is an uninhibited sympathetic nervous system response to a variety of noxious stimuli occurring in people with spinal cord injury at the thoracic six (T6) level and above Autonomic dysreflexia (AD) is a condition that is specific to people with a spinal cord injury (SCI). Any person who has an injury in the cervical spine or the thoracic spine at or above T6 is at risk for developing AD. This is a life-threatening medical emergency, so you and your family should be familiar with the symptoms, causes, and treatment Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity. J Neurotrauma 2003;20:707-16. Lindan R, Joiner E, Freehafer AA, et al. Incidence and clinical features of autonomic dysreflexia in patients with spinal cord injury Autonomic dysreflexia is a serious condition that occurs when, as a result of a spinal cord injury, nerve signals are blocked from reaching the brain. This condition can happen with spinal cord injuries at T6 or above. Dysreflexia is an emergency situation. When the bladder, bowels or skin are irritated, they send signals to the spinal cord and. Autonomic dysreflexia causes, symptoms, and signs. Autonomic dysreflexia is caused by irritating stimuli to the injury site. The autonomic nervous system (ANS) is responsible for many bodily.

Autonomic dysreflexia (A.D.) is a medical emergency. It occurs with a spinal cord injury of T6 or above, causing high blood pressure that may be life threatening. Causes: Full bladder (90% of cases), full bowel, pressure ulcer, bone fractures, infections, sex, tight clothing or shoes, blood clots, pregnancy or labor, bladder/kidney stones. A brief compilation of videos explaining the pathophysiology of autonomic dysreflexia / hyperreflexia Autonomic dysreflexia is the body's response to a miscommunication between the sympathetic autonomic nervous system and the parasympathetic autonomic nervous system, and can cause a super quick spike in blood pressure, which can ultimately lead to a stroke. A tell-tale sign of autonomic dysreflexia is a sudden, splitting headache Autonomic Dysreflexia Causes Nearly anything that bothers areas below one's level of injury can cause autonomic dysreflexia . It's not yet understood why some people experience autonomic dysreflexia more often than others, but all higher-level spinal cord injury patients should be aware of what can trigger the autonomic nervous system to.

Autonomic dysreflexia after spinal cord injury: Systemic pathophysiology and methods of management. Eldahan KC, Rabchevsky AG. Auton Neurosci, 209:59-70, 08 May 2017 Cited by: 21 articles | PMID: 28506502 | PMCID: PMC5677594. Review Free to rea Autonomic dysreflexia is a condition that occurs in patients with spinal cord injuries especially in the T5 and T6 levels. This condition is characterized by hyper activity of the autonomic. Autonomic Dysreflexia (AD) is a potentially life threatening complication of spinal cord injury that happens at T6 or above. AD is a medical emergency and should be treated immediately. The most common causes of AD are a bladder being too full, overfull bowel, pressure sore or irritated skin and sexual or reproductive activity Spinal autonomic dysreflexia is a condition in which the blood pressure in a person with a spinal cord injury (SCI) above T5-6 becomes elevated due to the excess Autonomic Nervous System activity. Pathophysiology. Autonomic Dysreflexia is usually caused when a painful stimulus occurs below the level of spinal cord injury autonomic dysreflexia to carry emergency medical/alert cards, giving a short summary of causes and treatment, which may assist medical practitioners in the community setting in the acute management of the condition

Autonomic Dysreflexia (Hyperreflexia) NCLEX Revie

  1. Autonomic Dysreflexia. Patients most at risk of AD are those with SCI above T6 who have passed through the acute stage of spinal cord injury (spinal shock). This is a medical emergency and must be treated with prompt action. High blood pressure can lead to heart arrythmias and stroke
  2. the history of autonomic dysreflexia (AD) • Define. autonomic dysreflexia (AD) • Understand. pathophysiology of AD • Identify • characteristics of AD • current treatment strategies used to prevent AD • current strategies used to manage AD • Understand. challenges in the identification, prevention and management of A
  3. Autonomic dysreflexia causes a rise in blood pressure and, combined with a low heart rate, this can lead to a stroke or heart failure if something isn't done. Nerve signals from the brain to the spinal cord generally control voluntary things like movement. The spine also has a role to play in autonomic or involuntary processes such as.
  4. Autonomic dysreflexia . Autonomic Dysreflexia (AD) is considered a Medical Emergency in Rehab Medicine- and for good reason. It is defined as a life-threatening condition, that can occur in patients with a spinal cord injury at the level of T6 (or above) because of unchecked sympathetic response
  5. Autonomic dysreflexia (AD), also known as hyperreflexia, is a condition unique to people with spinal cord injury (SCI). The condition occurs because the pathway for nerve signals is damaged following injury. Although persons with T6 levels of injury and above are at the highest risk for AD, it does rarely occur in persons with lower levels of.
  6. Autonomic dysreflexia is a potentially life-threatening medical emergency that can affect people with SCI at T6 and above. Autonomic dysreflexia involves a sudden rise in blood pressure, which may be accompanied by heart rate changes, headaches, sweating, and other symptoms. Autonomic dysreflexia can be triggered by any strong, irritating, or.

Autonomic dysreflexia - Causes, Symptoms, Diagnosis and

Spinal Cord Injury: Autonomic Dysreflexia Michigan Medicin

For individuals who are paralyzed Autonomic Dysreflexia can occur when a stimulus happens to the body below the level of injury. This can be a pain or irritant (such as tight clothing or something pinching the skin) or a normal function that the body may not notice (such as having a full bladder and needing to urinate).Temperature can be of special concern given the fact that the person has no. Unformatted text preview: ACTIVE LEARNING TEMPLATE: System Disorder STUDENT NAME_____ Autonomic Dysreflexia DISORDER/DISEASE PROCESS_____ REVIEW MODULE CHAPTER_____ Alterations in Health (Diagnosis) Autonomic Dysreflexia Pathophysiology Related to Client Problem injury to spinal cord in upper back; makes your blood pressure dangerously high and, coupled with very low heartbeats, can lead to a.

The pathophysiology of PSH is still poorly understood. Autopsy studies have not shown insight into an anatomic basis 3 . One hypothesis proposes that structural damage sustained after acquired brain injury results in disruption of higher-order autonomic regulatory centers, which may include the brainstem, midbrain, and cortical centers 10 Figure 3 Schematic of the pathophysiology of autonomic dysreflexia (AD). (A) Loss of supraspinal control over sympathetic preganglionic neurons is the primary cause of disordered blood pressure regulation and AD after spinal cord injury (SCI). (B) Increased sprouting of C-fibers (CGRP) within the dorsal horn of the sacral region enhances. Pure autonomic failure: People with this form of dysautonomia experience a fall in blood pressure upon standing and have symptoms including dizziness, fainting, visual problems, chest pain and tiredness. Symptoms are sometimes relieved by lying down or sitting. Cleveland Clinic is a non-profit academic medical center

Autonomic dysreflexia - Wikipedi

Autonomic dysreflexia is acute episodic hypertension resulting from sympathetic hyperactivity. Autonomic dysreflexia occurs to some extent in up to 90% of people with upper thoracic (above the neurologic level of T6) and cervical spinal cord injury (). 1 Although it can be asymptomatic, the signs and symptoms of autonomic dysreflexia generally include a sudden increase in blood pressure. Autonomic dysreflexia (AD), a potentially dangerous complication of high-level spinal cord injury (SCI) characterized by exaggerated activation of spinal autonomic (sympathetic) reflexes, can cause pulmonary embolism, stroke, and, in severe cases, death. People with high-level SCI also are immune compromised, rendering them more susceptible to infectious morbidity and mortality Autonomic dysreflexia is a potentially life threatening complication of spinal cord injury. It carries a mortality rate of 22%1 and increases the risk of stroke by 300% to 400%.2 Clinicians working in emergency or urgent care may not see patients with this condition often, but when they do, prompt recognition and treatment are required. This practice pointer gives a brief overview of autonomic.

Autonomic dysreflexia (AD), also known as hyperreflexia, can be a medical emergency that affects people with spinal cord injuries above T6. What causes AD? AD is caused when an irritation or strong sensation below the injury sends a signal to the spinal cord Autonomic Dysreflexia (AD) is a serious complication that may be experienced by a person with spinal cord injury. This video discusses signs, causes and methods on how to correct or prevent Autonomic Dysreflexia. This video is meant to be part of continued education What causes autonomic dysreflexia? The brain, spinal cord, and nerves act as a communication system for the body. Before an injury, messages travel freely between body and brain along these pathways. The spinal cord produces reflex responses in the body. The brain monitors and regulates these responses, controlling the body's movement and. Troubleshooting Autonomic Dysreflexia (AD) What is Autonomic Dysreflexia? Autonomic dyreflexia (AD), also called autonomic hyperreflexia is a condition that may occur in people with a spinal cord injury. Doctors believe it happens when nerve signals that start below the level of the spinal injury over-stimulate th A reflex is activated, causing overactivity from the autonomic nervous system, resulting in spasms and a narrowing of the blood vessels. In turn, this causes a rise in blood pressure, causing Autonomic Dysreflexia. Signs and symptoms of Autonomic Dysreflexia. Autonomic Dysreflexia symptoms can vary depending on the individual. However, there.

The most common cause for autonomic dysreflexia (AD) is bladder distention or swelling (e.g., due to a blocked catheter or detrusor sphincter dyssynergia), followed by bowel distension. Other causes: Bladder or kidney stones, urinary infection, bowel impaction, fracture, heterotopic bone, substance surgery. Pressure area, sunburn, ingrown toenail Autonomic dysreflexia can develop suddenly and is potentially life threatening and is considered a medical emergency. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. AD occurs when an irritating stimulus is introduced to the body below the level of spinal cord injury, such as an overfull bladder Causes of Autonomic Dysreflexia. AD usually occurs when there is some kind of negative stimulus below the site of the injury. A healthy individual would normally feel this stimulus, but in this. Autonomic dysreflexia can occur in susceptible individuals up to 40 times per day. This activity reviews the cause, pathophysiology and presentation of autonomic dysreflexia and highlights the role of the interprofessional team in its management

Autonomic hyperreflexia; Spinal cord injury - autonomic dysreflexia; SCI - autonomic dysreflexia. Causes. The most common cause of autonomic dysreflexia (AD) is spinal cord injury. The nervous system of people with AD over-responds to the types of stimulation that do not bother healthy people Autonomic dysreflexia can develop suddenly, and is a possible emergency situation. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. Autonomic dysreflexia means an over-activity of the Autonomic Nervous System Autonomic dysreflexia is a phenomenon experienced by about 20% to 70% of people who have a spinal injury above T6, according to a StatPearls book. Additionally, it is almost always an old spinal injury. Essentially, autonomic dysreflexia is an out-of-control autonomic response to an unfelt painful stimulus Autonomic dysreflexia (AD) is a condition that causes sudden, extremely high blood pressure. AD is most common in people with a spinal cord injury in the neck or upper back. DISCHARGE INSTRUCTIONS: Medicines: Medicines can help lower your blood pressure or soften your bowel movements. You may also need medicine to prevent an infection or. Traumatic spinal cord injury (SCI) has widespread physiological effects beyond the disruption of sensory and motor function, notably the loss of normal autonomic and cardiovascular control. Injury at or above the sixth thoracic spinal cord segment segregates critical spinal sympathetic neurons from supraspinal modulation which can result in a syndrome known as autonomic dysreflexia (AD)

Autonomic Dysreflexia: A Clinical Rehabilitation Proble

In simple terms, autonomic dysreflexia is an overreaction from your body's autonomic system to something happening below your level of injury, which can elevate your blood pressure to dangerous levels. There are many stimuli that can trigger autonomic dysreflexia. Some causes can be easily resolved, while others may require a trip to the ER Autonomic dysreflexia [i] (AD) is also known as autonomic hyperreflexia. It describes a situation where the body exhibits an exaggerated reflex response to a problem or stimulus. A person with a high spinal cord injury is likely to be unable to consciously sense and respond to a damaging or irritating stimulus Autonomic dysreflexia in wheelchair tennis athletes. Wheelchair athletes have a variety of medical conditions. One particular condition, called a spinal cord injury, can pose its own unique challenges. With a spinal cord injury, the brain cannot communicate well with the rest of the body. Some individuals may have weakness in the legs. Autonomic dysreflexia is a potentially dangerous and, in rare cases, fatal clinical syndrome that develops in individuals with SCI, resulting in acute, uncontrolled hypertension. All caregivers, practitioners, and therapists who interact with individuals with SCIs must be aware of this syndrome, recognize the symptoms, and understand the causes autonomic dysreflexia and autonomic hyperreflexia are interchangeable terms. it occurs after resolution of spinal shock and in patients with spinal cord injury at or above t6 and is an emergency. according to my mccance and heuther (pathophysiology:.

Autonomic dysreflexia (AD) is a condition in which your involuntary nervous system overreacts to external or bodily stimuli. It's also known as autonomic hyperreflexia.This reaction causes: a dangerous spike in blood pressure. constriction of your peripheral blood vessels Autonomic dysreflexia is a medical emergency that can occur in people who have a spinal cord injury (SCI) at or above the sixth thoracic (T6) level. It is the body's abnormal response to a painful or harmful stimulus, such as an overfull bladder or bowel. This abnormal response causes abrupt rise in blood pressure

Autonomic Dysreflexia Definition. Autonomic dysreflexia (AD) is a sudden rise in blood pressure in a person who has had a spinal cord injury. AD can be deadly. It needs care right away. Causes. Pain causes an automatic increase in blood pressure. Normally, the brain receives messages about the rise in blood pressure and takes steps to lower it Autonomic Hyperreflexia Pathophysiology . Autonomic dysreflexia is one of the major medical emergencies that are most common to override the spinal cord injury sufferers. This creates activity over the autonomic nervous system, causing a sudden excessive incidence of high blood pressure

Most people think that Spinal Cord Injury is simply the inability to walk. They couldn't be more wrong. That is just the surface of a long list of problems. One of those problems I face is Autonomic Dysreflexia (AD). If you want to know the medical definition, I encourage you to look it up and do some research Dysautonomia or autonomic dysfunction is a condition in which the autonomic nervous system (ANS) does not work properly. This may affect the functioning of the heart, bladder, intestines, sweat glands, pupils, and blood vessels.Dysautonomia has many causes, not all of which may be classified as neuropathic. A number of conditions can feature dysautonomia, such as Parkinson's disease, multiple. Autonomic dysreflexia is an acute, life-threatening condition which occurs in those who have a spinal cord lesion at or above the level of the 6th thoracic vertebra. Untreated, it can lead to potentially fatal complications including seizures, retinal detachment, intracranial haemorrhage and pulmonary oedema. The commonest causes are bladde

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