In Spinal cord injured patients, complications involving autonomic system are well known, such as orthostatic hypotension or autonomic dysreflexia. However, symptomatic cardiac dysfunction showing bradycardia accompanied by hypotension is a feature unique to cervical cord injured patients that are rarely shown in patients with other parts of cord injuries. This feature is definitely not uncommon but not well recognized yet. The study case was a 45-year old man with C4 complete quadriplegia and was transferred to rehabilitation department about 50-days postinjury. Clinical features were severe brady cardia and hypotension accompanied with subjective symptomes of dizziness, headache and lethargy. The pulse rates were down below 40/min twice in our service admission period and succeeded in raising the pulse rate to obtimal level with administration of atropine 0.5mg. The feature with bradycardia, arrhythmia and hypotension can be stated by a result of breakdown of the balance between sympathetic nervous system and parasympathetic nervous system that could lead to unopposed vasovagal reflex activities. The treatment for the feature can be either a vagolytics or a sympathommimetics and the dosage can be lowered and canceled syncronously with the return of the reflex spinal cord activity after the spinal shock period. Physiatrists need to be aware of the risk of cardiac dysfunction in the spinal cord injured patients.

Keywords :Spinal cord injury, Bradycardia, Hypotension, Autonomic dysfunction