Introduction

Postprandial hypotension is a type of autonomic dysfunction where there is a decrease in systolic blood pressure of >20 mm HG within 2 h after eating thought to be due to poor cardiovascular compensation for splanchnic blood pooling that occurs with meals. This form of autonomic dysfunction is underdiagnosed in patients with spinal cord injury, likely in part because it can be asymptomatic.

Case presentation

26-year-old with complete cervical spinal cord injury (SCI) presented with neck pain described as severe 10/10 pain, which felt like “a rope around his neck.” Pain came on during and after meals and was associated with a feeling of pressure behind his eyes, white spots in his vision along with feeling as if he was going to pass out. The caregiver noted a systolic blood pressure drop by about 30–40 points with meals and lost weight due to avoiding eating. A diagnosis of post-prandial hypotension (PPH) was made and Acarbose was started at a low dose 25 mg three times per day with meals. During follow up, the patient reported complete resolution of drops of blood pressure, neck pain, and all associated symptoms. The patient was able to eat comfortably and gained weight.

Discussion

There are few case reports on PPH in SCI and none looking at acarbose on a young, nondiabetic person with SCI. Clinicians should be aware that PPH can occur in young otherwise healthy people with SCI. Further research is needed on PPH, including the use of acarbose, in the SCI population.

中文翻译：

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阿卡波糖治疗成人颈脊髓损伤餐后低血压一例

介绍

餐后低血压是一种自主神经功能障碍，其中进食后2小时内收缩压降低>20mm HG，这被认为是由于进餐时发生的内脏血液汇集的心血管代偿不良所致。这种形式的自主神经功能障碍在脊髓损伤患者中未被充分诊断，部分原因可能是它可能是无症状的。

案例展示

26 岁，患有完全性颈脊髓损伤 (SCI)，颈部疼痛被描述为严重的 10/10 疼痛，感觉就像“脖子上有一根绳子”。饭后和饭后会出现疼痛，并伴随着眼睛后面的压力感、视野中出现白点以及感觉好像要昏倒一样。护理人员注意到，进餐后收缩压下降了约 30-40 点，并且由于避免进食而体重减轻。诊断为餐后低血压 (PPH)，并开始服用阿卡波糖，每次 25mg，每天 3 次，随餐服用。在随访过程中，患者报告血压下降、颈部疼痛和所有相关症状完全消失。患者能够舒适地进食并且体重增加。

讨论

关于 SCI 中 PPH 的病例报告很少，也没有关于阿卡波糖治疗患有 SCI 的年轻非糖尿病患者的病例报告。临床医生应该意识到 PPH 可能发生在其他健康的 SCI 年轻患者身上。需要对 PPH 进行进一步研究，包括在 SCI 人群中使用阿卡波糖。