Autonomic Dysreflexia

Autonomic dysreflexia (AD) is a potentially life-threatening medical emergency.

It affects people with spinal cord injuries at the T6 level or higher. Although rare, some people with T7 and T8 injuries can also develop AD.

For most people, AD can be easily treated as well as prevented. The key is knowing your baseline blood pressure, triggers and symptoms.

What to do if AD is suspected:

Most importantly, locate and remove the offending stimulus, if possible.

Begin by looking for your most common causes: bladder, bowel, tight clothing, skin issues.

NOTE: Keep in mind when you remove the cause that your AD may get worse before it gets better.

Then follow these steps:

  1. Sit up or raise your head to 90 degrees. If you can lower your legs, do so.
  2. Loosen or remove anything tight
  3. Check blood pressure every five minutes

NOTE: An individual with SCI above T6 often has a normal systolic blood pressure in the 90–110 mm Hg range.

What is yours?

The following blood pressure readings may be a sign of autonomic dysreflexia:

  1. 20 mm to 40mm Hg above baseline in adults
  2. 15mm above baseline in children
  3. 15mm to 20mm above baseline in adolescents.

IMPORTANT: Stay sitting up until blood pressure is normal

Seek prompt medical advice if the cause cannot be identified or the hypertension cannot be controlled. Tell the doctors and nurses that you may have dysreflexia, need to have your blood pressure checked, need to stay sitting up, and need to find what's causing it.

If the hypertension is severe, or the cause still cannot be identified, you will need to be treated with medication.

Medications are generally used only if the offending trigger/stimulus cannot be identified and removed – or when an episode persists even after removal of the suspected cause.

Some of the signs of AD

Some of the signs of AD include high blood pressure, pounding headache, flushed face, sweating above the level of injury, goose flesh below the level of injury, nasal stuffiness, nausea and a slow pulse (slower than 60 beats per minute).

Some of the causes of AD

Autonomic Dysreflexia is caused by an irritant below the level of injury, usually related to bladder or bowel, such as:

  • irritation of the bladder wall, urinary tract infection, blocked catheter or overfilled collection bag
  • distended or irritated bowel, constipation or impaction, hemorrhoids or anal infections.

Other causes include:

  • skin infection or irritation,cuts, bruises, abrasions or pressure sores (decubitus ulcers), ingrown toenails
  • burns (including sunburn and burns from hot water)
  • tight or restrictive clothing
  • AD can also be triggered by sexual activity, menstrual cramps, labor and delivery, ovarian cysts
  • abdominal conditions (eg gastric ulcer, colitis, peritonitis)
  • or bone fractures.
To read more about Autonomic Dysreflexia, click here