Autonomic Dysreflexia

Definition

Autonomic dysreflexia (AD) is a condition that affects patients with spinal cord injuries. Abnormal autonomic nervous system function causes the body to respond inappropriately to a problem below the level of a spinal cord injury. The autonomic nervous system controls involuntary body functions like digestion, heart rate, and breathing rate.

When there is a problem in your body below the level of your spinal cord injury (like an overfull bladder), your body tries to send nerve signals to your brain. But because of the spinal cord injury, the messages cannot reach your brain. This causes a reaction that can make your blood pressure rise to dangerous levels. Because of your spinal cord injury, your brain cannot send messages below the level of the injury to regulate your blood pressure.

AD can be serious. If it is not treated right away, it can lead to seizures, stroke, and death. Treatment is aimed at finding and eliminating the problem that started the reaction.

Causes

AD can be caused by anything that would have been painful or physically uncomfortable before your spinal cord injury. The most common cause of AD is an overfull bladder. Your bladder may become overfull due to a blockage in your catheter, infection ( cystitis), spasms, or stones.

Other causes of AD include:

• Bowel that is full of gas or stool
• Clothing that is too tight
• Skin irritations
• Wounds
• Pressure sores
• Burns
• Broken bones
• Labor in pregnant women
• Menstrual cramps
• Sexual activity that would be painful if you had full sensation
• Ingrown toenails
• Appendicitis
• Gastric ulcer

Risk Factors

AD occurs in people who have spinal cord injuries at the level of T6 and above (high in your back). It is also more common in people with recent spinal cord injuries.

Parts of The Spine

AD occurs in people with injuries in the thoracic area of their spinal cord.

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Symptoms

Symptoms may include:

• Pounding headache (caused by the rise in blood pressure)
• Sweating above the level of spinal cord injury
• Nasal congestion
• Blurry vision
• Slow pulse
• Blotchy skin above the level of spinal cord injury
• Feeling restless
• Flushed (reddened) face
• Chest tightness
• Nausea
• Goose bumps below the level of spinal cord injury
• Cold, clammy skin below the level of spinal cord injury

Sometimes you will have no symptoms at all.

If you check your blood pressure, you will notice that it is increased.

Diagnosis

AD is suspected when the symptoms above are present or when blood pressure is elevated in someone with a spinal cord injury at the T6 level and above.

Treatment

Treatment depends on the cause of AD. The main goal of treatment is to remove whatever is causing AD as soon as possible. If you think you have AD, you should:

• Sit upright to lower your blood pressure.
• Elevate your head and lower your legs if possible.
• Take frequent blood pressure checks until the episode is over.
• Loosen or remove any clothes, shoes, leg braces, external catheter tape, or straps.
• Check your bladder. An overfull bladder is one of the most common causes of AD.
• If you think your bowels may be a cause, do a bowel program if you can. You should use lidocaine gel for to numb the area for digital stimulation. If AD is happening during a bowel program, stop the procedure. You can start again after your symptoms go away.
• Look for another problem that may be causing AD. If you cannot find a cause or if symptoms are continuing or getting worse, call for medical help right away.

After the problem has been addressed, you should stay in an upright position and have your blood pressure checked frequently until you are feeling normal.

Blood pressure lowering medicines may be given during the event to help lower your blood pressure.

Prevention

Preventing AD is very important. If you have an indwelling urinary catheter, take these steps to prevent problems that could lead to AD:

• Make sure the tubing is free of kinks.
• Empty the drainage bags regularly.
• Make sure the drainage bag is at a level lower than your bladder.
• Check the catheter daily for signs of wear or problems with any piece of the catheter.

Other steps you can take to prevent AD include:

• Empty your bowels regularly.
• Avoid tight or restrictive clothing.
• Check your skin regularly for signs of wounds or pressure sores.
• Avoid things that could burn or damage your skin (eg, sun exposure, extremely hot water).
• Follow up with your medical team regularly to monitor your condition.

If you have a spinal cord injury, you should carry an AD medical alert card with you. This can alert people you are with if you have symptoms of AD.