Friday, July 6, 2012

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Ice water test - Traumatic spinal cord injury

This test was first described by Bors and Blinn in 1957. The authors did this test to check if there are any temperature receptors in the bladder, how they work and whether the test can have a diagnostic purpose.

Procedure: (originally done by Bors and Blinn)
60 mL of ice cold water is instilled in the bladder in 30 seconds and patient is requested to try to retain the fluid.

If water is expelled in less than 1 minute, the test is said to be positive.

The rapid evacuation of the fluid is due to the reflex contraction of the detrusor muscle. The authors also found that this test was positive in patients having an upper motor neuron lesion.
The physiology behind is that there are cold receptors in the bladder wall. From there, the impulses travel through the afferent C fibers to the spinal cord and return via the motor nerves to the detrusor muscle thereby completing the reflex arc. This reflex is normally present in children up to the age of 4. After this age, it becomes inhibited centrally.