Autonomic Dysreflexia

(AD; Hyperreflexia)

by Cynthia M. Johnson, MA

Definition

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.

Causes

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:

A full bladder (common) or a blockage in a catheter
A bowel that is full of gas or stool
Clothing that is too tight
Wounds or pressure sores
Skin infection or irritation
Gallstones
Burns
Broken bones
Menstrual cramps
Painful sexual activity
Labor in pregnant women
Ingrown toenails
Appendicitis
Gastric ulcer

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

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

Symptoms

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

Diagnosis

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.

Treatment

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.

Prevention

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

RESOURCES:

National Institutes of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov

Paralyzed Veterans of America
http://www.pva.org

CANADIAN RESOURCES:

Canadian Orthopaedic Association
http://www.coa-aco.org

Spinal Cord Injury Canada
http://sci-can.ca

References:

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: https://www.dynamed.com/management/management-of-chronic-spinal-cord-injury. 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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