Autonomic dysreflexia (AD) is an emergency situation presented by individuals that have a T-5, or higher, spinal cord injury. It is important to be able to recognize this complication, know what causes it, and how to treat it as it can be life-threatening.

        [What are the indicators for the onset of AD?]
        [What sort of things can precipitate this syndrome?]
        [What can be done to manage an episode of autonomic dysreflexia?]
        [How can autonomic dysreflexia be prevented?]

What are the indicators for the onset of AD?

1.     Hypertension (blood pressure greater than 200/100). Uncontrolled high blood pressure is the dangerous part of autonomic dysreflexia, for it may be high enough to cause a stroke.

2.     Pounding headache

3.     Flushed (reddened) face

4.     Red blotches on the skin above level of spinal injury

5.     Sweating above level of spinal injury

6.     Nasal stuffiness

7.     Nausea (secondary to vagal parasympathetic stimulation) 

8.     Bradycardia - slow pulse <60 beats per minute

9.     Piloerection ("goose bumps") below level of spinal injury 

10.     Cold, clammy skin below level of spinal injury 

[Top]

What sort of things can precipitate this syndrome?

Irritants, things which would ordinarily cause pain, to areas of body below the level of spinal injury. 

Things to consider include:

1.     Bladder (most common) - from overstretch or irritation of bladder wall 

          Urinary tract infection (UTI)
          Urinary retention 
          Blocked catheter 
          Overfilled collection bag 
          Non-compliance with intermittent catheterization program 

2.     Bowel - overdistention or irritation 

          Constipation / impaction 
          Distention during bowel program (digital stimulation) 
          Hemorrhoids or anal infections
          Infection or irritation

3.     Skin-related Disorders 

          Any direct irritant below the level of injury (eg. - prolonged pressure by object in 
          shoe or chair, cut, bruise, abrasion) 
          Pressure sores (decubitus ulcer) 
          Ingrown toenails 
          Burns (eg. - sunburn, burns from using hot water) 
          Tight or restrictive clothing or pressure to skin from sitting on wrinkled clothing 

4.     Sexual Activity 

         Overstimulation during sexual activity [stimuli to the pelvic region which would
         ordinarily be painful if sensation were present] 
         Menstrual cramps 

5.     Labor and delivery 

6.     Other 

          Heterotopic ossification ("Myositis ossificans", "Heterotopic bone") 
          Acute abdominal conditions (gastric ulcer, colitis, peritonitis) 
          Skeletal fractures 

[Top]

Sit up if you are lying down. This will decrease your blood pressure.

Locate and remove the offending stimulus whenever possible.  Autonomic dysrefiexia usually will not go away until the cause of the problem has been corrected. This will often prove successful enough to avoid pharmacological intervention.  Once the source of irritation has been removed it will be a good idea to have the individual remain in a sitting up position and take frequent blood pressure checks until the episode has ended.

Typical Causes

Bladder / Blocked Catheter

The most common cause of AD is a catheter that has become blocked.  You will want to check the collection bag, irrigate the catheter and remove any kinks. If you do not have a catheter in place, catheterize yourself. Empty your bladder slowly by lifting the draining end of your catheter. If you empty your bladder too fast, you may cause it to go into spasm, which can cau se your blood pressure to go up again.

Bowel

If symptoms begin while digital stimulation is being performed, stop until symptoms quit.  If the individual has impacted stool - begin disimpaction immediately.  If digital stimulation continues to bring on the symptoms you may want to consider abdominal massage or commode-based bowel evacuation methods.

Skin

Skin irritation, also a common cause of AD, is most often stopped by loosening the clothing.  You will was to check for pressure sores and toenail problems.

[Top]

How can autonomic dysreflexia be prevented?

     Frequent pressure relief in bed/chair 

    Avoidance of sun burn/scalds (avoid overexposure, use of #15 or greater sunscreen, 
    watch water temperatures) 

    Faithful adherence to bowel program

    Keep catheters clean and remain faithful to intermittent catheterization schedule 

    Well balanced diet and adequate fluid intake 

    Compliance with medications 

[Top]