Autonomic dysreflexia

Background

• a syndrome of massive imbalanced reflex sympathetic discharge
• occurring in patients with spinal cord injury (SCI) above the splanchnic sympathetic outflow (T5-T6)
• a medical emergency given dangerous sequelae of elevated blood pressure

Diagnosis

History

1. blurry vision
2. headaches
3. sense of anxiety

Physical

1. A sudden significant rise in systolic and diastolic blood pressures
   1. usually associated with bradycardia,
   2. SBP >140 mm Hg (in a patient with SCI above T6)
2. profuse sweating/flushing above the level of lesion (especially in the face, neck, and shoulders)
3. Possible to be asymptomatic

Treatment

1. Check urinary catheter for any blockage or twisting
2. placed in an upright position
3. careful inspection of nonsensate areas to identify the source of painful stimuli
   1. (e.g. catheter, restrictive clothing, leg bag straps, abdominal supports, orthoses)