DOI: 10.36347/sjmcr.2017.v05i09.012

Pages: 550-554

A 61-year-old man could not move after heavily drinking alcohol and fell down. Upon arrival at our hospital, he showed abdominal breathing, paraplegia and bradycardia. Based on a high-intensity signal from C4 through C6 on magnetic resonance imaging (MRI), he was diagnosed with spinal cord injury (SCI). On the morning of day 5 of hospitalization, he suddenly entered sinus arrest after a short duration of bradycardia. He was resuscitated after immediate chest compression. ST- segment elevation on ECG and high levels of serum troponin I suggested acute coronary syndrome (ACS). There was no stenosis of any coronary arteries on coronary angiography. After the injection of acetylcholine chloride (50 μg) into the left coronary artery, excessive spasm and contrasting delay appeared. We diagnosed coronary spastic angina (CSA) and administered vasodilators. After rehabilitation, he recovered his ability to walk. He had neither cerebral hypoxia nor angina. Cardiovascular complications often occur with SCI above T6, due to hyperactivity of the parasympathetic nerve system. These complications are particularly likely during the first two to three weeks after injury. Careful management is necessary to avoid fatal cardiovascular complications of not only bradycardia, but also CSA during the acute phase of SCI.