Autonomic Dysreflexia

(AD; Hyperreflexia)


Autonomic dysreflexia (AD) is a sudden rise in blood pressure in a person who has had a spinal cord injury.

AD can be deadly. It needs care right away.


Pain causes an automatic increase in blood pressure. Normally, the brain receives messages about the rise in blood pressure and takes steps to lower it. With AD, the message cannot reach the brain because of the spinal cord injury. This causes the blood pressure to rise to dangerous levels.

AD can be caused by anything that would have caused discomfort before a person's spinal cord injury. Some of the things that can trigger AD are:

Risk Factors

The risk of this problem is higher in people who have spinal cord injuries in the upper back. It is also more common in people with a recent spinal cord injury.

Parts of the Spine

si1936_parts of spine
AD happens in the thoracic area of people with spinal cord injuries.
Copyright © Nucleus Medical Media, Inc.


Some people may not have symptoms. Others may have:

  • Severe headache
  • A flushed (red) face
  • Sweating above the level of the spinal cord injury
  • Goose bumps below the level of spinal cord injury
  • Chest tightness
  • Restlessness
  • Blurry vision
  • A stuffy nose


The doctor will ask about your symptoms and health history. You will be asked about your spinal cord injury. A physical exam will be done. This is often enough to make the diagnosis.


The cause of AD should be treated right away, such as emptying a full bladder. The person should also sit upright to move more blood to the lower body to ease pressure.

Emergency care will be needed. Medication will be given to lower blood pressure quickly. It may be given by IV.


The risk of AD may be lowered by avoiding problems that can trigger AD, such as:

  • Emptying the bowel and bladder regularly
  • Checking the skin for signs of damage, such as wounds or ingrown toenails
  • Wearing clothing that is not too tight


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:
...(Click grey area to select URL)
Accessed January 26, 2021.
Eckert MJ, Martin MJ. Trauma: Spinal Cord Injury. Surg Clin North Am. 2017 Oct;97(5):1031-1045.
Eldahan KC, Rabchevsky AG. Autonomic dysreflexia after spinal cord injury: systemic pathophysiology and methods of management. Auton Neurosci. 2017; S1566-0702(17)30113-3
Management of chronic spinal cord injury. EBSCO DynaMed website. Available at: Accessed January 25, 2021.
Last reviewed December 2020 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 1/26/2021

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