Autonomic dysreflexia (AD) is a dangerous rise in blood pressure in people with spinal cord injuries.
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.
Pain can cause an increase in blood pressure. In people with spinal lesions, pain may not be felt, but can stimulate a physical reaction. In particular, local blood vessels shrink in response to the pain which increases blood pressure. Normally, the brain will receive messages about the increase in blood pressure and take steps to lower the blood pressure back to normal. With AD, the message cannot reach the brain because of the spinal injury. As a result, the blood pressure continues to rise to dangerous levels.
AD can be caused by anything that would have been painful or physically uncomfortable before your spinal cord injury. The pain stimulation most often associated with AD is an overfull bladder. A blockage in your catheter, an infection, bladder spasms, or stones can all create pain stimulation.
Other factors that may cause pain stimulation include:
AD occurs more often in people who have spinal cord injuries at the level of T6 and above (upper back). It is also more common in people with recent spinal cord injuries.
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Symptoms may not occur. In those that have them, symptoms may include:
AD is suspected when:
AD is treated by addressing the problem causing it. Steps to take at home include:
After the problem has been addressed:
If you cannot find a cause or if symptoms are continuing or getting worse, call for medical help right away. Medical care may include blood pressure lowering medication and monitoring.
If you have a spinal cord injury, carry an AD medical alert card with you. This can alert people you are with if you have symptoms of AD and what steps to take.
Preventing AD is important. If you have an indwelling urinary catheter, take these steps to prevent problems that could lead to AD:
Other steps you can take to prevent AD include:
National Institutes of Arthritis and Musculoskeletal and Skin Diseases
Paralyzed Veterans of America
Canadian Orthopaedic Association
Spinal Cord Injury Canada
Autonomic dysreflexia. The National Spinal Cord Injury Association website. Available at:
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Accessed November 10, 2017.
Eldahan KC, Rabchevsky AG. Autonomic dysreflexia after spinal cord injury: systemic pathophysiology and methods of management. Auton Neurosci. 2017; S1566-0702(17)30113-3
Spinal cord injury—chronic management. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T566521/Spinal-cord-injury-chronic-management . Updated September 7, 2017. Accessed November 10, 2017.
Last reviewed November 2018 by
EBSCO Medical Review Board
Rimas Lukas, MD
Last Updated: 12/20/2014