1200 - A Unique Case of Detrusor Sphincter Dyssynergia Triggered by Varicella Infection

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

Dylan W. Banks, MD

Resident
New York University, PM&R Residency
New York, New York, United States

Co-Author(s)

ML

Max W. Lee, MD

Resident Physician
NYU Rusk Rehabilitation
New York, New York, United States
CC

Christopher Chiodo Ortiz, MD, MS

Resident
New York University, PM&R Residency
New York, New York, United States
MM

Margaret Martinez, DO

Resident
New York University, PM&R Residency
New York, New York, United States
AB

Amit K. Bansal, DO

Clinical Instructor, Department of Rehabilitation Medicine
NYU Grossman School of Medicine
New York,, New York, United States

Case Diagnosis: Detrusor sphincter dyssynergia

Case Description: A 36-year-old female with no medical history was admitted to acute inpatient rehabilitation after she sustained a traumatic cervical injury with C5 ASIA A spinal cord injury (SCI) requiring a C5 corpectomy, C4-C6 ACDF and C2-T1 posterior fusion. Six weeks post-injury, she developed varicella positive vesicles on her right arm. She was diagnosed with shingles of the C5 dermatome. Concurrently, the patient developed new severe headaches that recurred every 3-4 hours and resolved only with urination. During these episodes, systolic blood pressure was 190-200’s mmHg, concerning for autonomic dysreflexia (AD). This was atypical because she had previously progressed in bladder management to voiding spontaneously. Bladder scans revealed low volumes consistently below 200 cm3. Given the severity of symptoms, a foley was trialed which led to resolution of headaches. The patient completed a 10-day course of valacyclovir and her lesions crusted over. The foley was then removed without recurrence of headaches.

Discussions: Detrusor sphincter dyssynergia (DSD) is a urologic abnormality seen in patients with neurologic injuries in which the bladder contracts discordantly against a closed urethral sphincter. This results in urinary outflow obstruction with high intravesical pressure and can lead to issues such as AD, most commonly presenting with severe headaches, as observed in this case. We suspect this patient developed increased detrusor activity precipitated by the shingles infection, resulting in transient DSD. This is a pathomechanism not previously described.

Conclusions: The current literature linking shingles and bladder function is quite limited, comprised of case reports of shingles neuritis causing flaccid bladder and suprasacral shingles myelitis causing spastic bladder in patients without SCI (2,3). We present a case of new-onset DSD in a SCI patient triggered by a varicella infection. Given the observed bladder overactivity, the pathomechanism may be related to that of myelitis but remains ultimately unclear.