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.
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:
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 may include:
Sometimes you will have no symptoms at all.
If you check your blood pressure, you will notice that it is increased.
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 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:
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.
Preventing AD is very 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:
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.
National Institutes of Arthritis and Musculoskeletal and Skin Diseases
Paralyzed Veterans of America
Canadian Orthopaedic Association
Canadian Paraplegic Association
Autonomic dysreflexia. The National Spinal Cord Injury Association website. Available at: http://www.spinalc... . Accessed January 18, 2012.
Autonomic dysreflexia. PDF download. Paralyzed Veterans of America website. Available at: http://www.pva.org... . Accessed January 19, 2012.
Other complications of spinal cord injury: autonomic dysreflexia (hyperreflexia). University of Miamai/Jackson Memorial Medical Center, Louis Calder Memorial Library website. Available at: http://calder.med.miami.edu/pointis/automatic.html . Accessed January 18, 2012.
Spinal cord injury – chronic management. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 1, 2011. Accessed January 20, 2012.
Last reviewed January 2012 by Cynthia B. Brown, MD
Last updated 1/25/2012