Autonomic dysreflexia (AD) is a sudden rise in blood pressure in a person who has had a spinal cord injury.
AD can be deadly. It needs care right away.
Pain causes blood pressure to rise. When this happens the brain gets messages about the rise in blood pressure and takes steps to lower it. With AD, the message cannot reach the brain because of the spinal cord injury. This causes the blood pressure to rise to dangerous levels.
AD can be caused by anything that would have caused discomfort before a person's spinal cord injury. Some of the things that can trigger AD are:
- A full bladder (common) or a blockage in a catheter
- A bowel that is full of gas or stool
- Clothing that is too tight
- Wounds, pressure sores, skin infection, or irritation
- Gallstones, appendicitis, or gastric ulcer
- Broken bones
- Menstrual cramps
- Painful sexual activity
- Labor in pregnant women
- Ingrown toenails
The risk of this problem is higher in people who have spinal cord injuries in the upper back. It is also more common in people with a recent spinal cord injury.
AD happens in the thoracic area of people with spinal cord injuries.
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Some people may not have symptoms of AD. Others may have:
- Severe headache
- A flushed (red) face
- Sweating above the level of the spinal cord injury
- Goose bumps below the level of spinal cord injury
- Chest tightness
- Blurry vision
- A stuffy nose
The doctor will ask about symptoms and health history. The doctor will also ask about the spinal cord injury. A physical exam will be done. This is often enough to make the diagnosis.
The goal of treatment is to reduce the blood pressure to a safe level. The cause of AD should be treated right away, such as emptying a full bladder. The person should also sit upright to move more blood to the lower body. This can help ease pressure.
Emergency care will be needed. Medicine will be given to lower blood pressure quickly. It may be given by IV.
The risk of AD may be lowered by avoiding problems that can trigger it, such as:
- Emptying the bowel and bladder regularly
- Checking the skin for problems like wounds or ingrown toenails
- Wearing clothing that is not too tight
- Autonomic dysreflexia. Northwest Regional Spinal Cord Injury System website. Available at: https://sci.washington.edu/info/forums/reports/autonomic_dysreflexia.asp.
- Eckert, M.J. and Martin, M.J.. Trauma: Spinal Cord Injury. Surg Clin North Am, 2017; 97 (5): 1031-1045.
- Eldahan, K.C., and Rabchevsky, A.G.. Autonomic dysreflexia after spinal cord injury: systemic pathophysiology and methods of management. Auton Neurosci, 2018; 209: 59-70.
- Management of chronic spinal cord injury. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/management-of-chronic-spinal-cord-injury.
- Rimas Lukas, MD
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