Autonomic Dysreflexia

Autonomic dysreflexia (AD) is a condition that is specific to people with a spinal cord injury (SCI). Any person who has an injury in the cervical spine or the thoracic spine at or above T6 is at risk for developing AD. This is a life-threatening medical emergency, so you and your family should be familiar with the symptoms, causes, and treatment.

What Happens?

AD occurs when there is some kind of irritation or problem with your bodily functions below the level of your injury. You nerves attempt to send signals to your brain to alert you that something is wrong.

However, due to your SCI, these messages are blocked from reaching your brain. So, special nerves that work automatically cause the blood vessels below your level of injury to constrict or narrow. This results in a rapid increase in your blood pressure.

Your brain can detect the increase in your blood pressure, so it tries decrease your blood pressure by decreasing your heart rate, causing the blood vessels above the level of injury to relax and open wider (this may cause your face and neck to become red and blotchy). Your brain also attempts to send messages below the level of injury to stop squeezing your blood vessels closed.

Unfortunately, because the messages do not travel correctly through the spinal cord, your blood pressure may continue to rise. If left untreated, this may lead to stroke, seizure, or death.

Causes of Autonomic Dysreflexia

AD can be caused by anything that would normally be a painful or an uncomfortable condition that occurs below the level of your injury. The most common cause of AD is an overfull bladder or bowel. Other conditions that may cause AD include:

• Bladder spasms
• Urinary tract infections
• Kidney or bladder stones
• Stomach issues, such as ulcers
• Appendicitis
• Gallstones
• Sexual activity
• Skin conditions, such as pressure ulcers or burns
• Injuries to legs, such as ingrown toenails
• Blood clots
• Broken bones
• External factors, such as extreme temperatures or too-tight clothing, belts, or shoes

Symptoms of Autonomic Dysreflexia

The most common symptoms associated with AD include:

• Pounding headache
• Sweating above the level of your injury
• Red, blotchy skin above the level of your injury
• Goose bumps
• Chills without fever
• Blurry vision
• Stuffy nose
• Anxiety or jittery feeling
• Chest tightness and trouble breathing

Most important, your blood pressure will rapidly increase by 20  to 40 points from your baseline, and your heart rate may slow down.

If You Are Experiencing an Episode of Autonomic Dysreflexia

If you experience an episode of AD, you need to figure out the cause and fix it.

First, you should get into the sitting position or elevate you head as much as possible. This will help to drop your blood pressure. Since bladder issues are the most common cause of AD, you or a caregiver should check your bladder. If you manage your bladder through intermittent catheterization, you or your caregiver should catheterize your bladder. If you have an indwelling catheter, check for kinks or blockage, and make sure your drainage bag is not too full. Irrigate your catheter to clear any blockage.

Next, check for bowel issues. You or your caregiver should perform digital stimulation to empty your bowel. Loosen any tight or restrictive clothing, such as belts or abdominal binder, untie shoes, and if you wear support hose, remove them. Check your bed or wheelchair to make sure you are not sitting on anything that may be causing pressure.

If your symptoms persist, or if your systolic blood pressure goes above 150 and stays there after you have checked all the above causes, you may need to use medications prescribed by your doctor to decrease your blood pressure. These medications should only be used as prescribed by your physician.

You also should seek emergency medical treatment if you are unable to get your symptoms to resolve.