Autonomic dysreflexia: Difference between revisions
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==Background== | ==Background== | ||
* | *Syndrome of massive imbalanced reflex sympathetic discharge, both directly on vasculature and indirectly through catecholamine release from adrenal medulla | ||
* | *Carotid and aortic baroreceptors result in strong vagal response with bradycardia and vasodilation above level of injury, but cannot inhibit sympathetics below level of injury - HTN remains dysregulated by the CNS | ||
* | *Occurring in patients with spinal cord injury (SCI) above the splanchnic sympathetic outflow (T5-T6) | ||
*Medical emergency given dangerous sequelae of elevated blood pressure | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 15:04, 24 March 2015
Background
- Syndrome of massive imbalanced reflex sympathetic discharge, both directly on vasculature and indirectly through catecholamine release from adrenal medulla
- Carotid and aortic baroreceptors result in strong vagal response with bradycardia and vasodilation above level of injury, but cannot inhibit sympathetics below level of injury - HTN remains dysregulated by the CNS
- Occurring in patients with spinal cord injury (SCI) above the splanchnic sympathetic outflow (T5-T6)
- Medical emergency given dangerous sequelae of elevated blood pressure
Diagnosis
History
- blurry vision
- headaches
- sense of anxiety
Physical
- A sudden significant rise in systolic and diastolic blood pressures
- usually associated with bradycardia,
- SBP >140 mm Hg (in a patient with SCI above T6)
- profuse sweating/flushing above the level of lesion (especially in the face, neck, and shoulders)
- Possible to be asymptomatic
Differential Diagnosis
Hypertension
- Hypertensive emergency
- Stroke
- Sympathetic crashing acute pulmonary edema
- Ischemic stroke
- Intracranial hemorrhage
- Preeclampsia/Eclampsia
- Autonomic dysreflexia
- Scleroderma renal crisis
- Acute glomerulonephritis
- Type- I myocardial infarction
- Volume overload
- Urinary obstruction
- Drug use or overdose (e.g stimulants, especially alcohol, cocaine, or Synthroid)
- Renal Artery Stenosis
- Nephritic and nephrotic syndrome
- Polycystic kidney disease
- Tyramine reaction
- Cushing's syndrome
- Obstructive sleep apnea
- Pheochromocytoma
- Hyperaldosteronism
- Hyperthyroidism
- Anxiety
- Pain
- Oral contraceptive use
Treatment
- Check urinary catheter for any blockage or twisting
- placed in an upright position
- careful inspection of nonsensate areas to identify the source of painful stimuli
- (e.g. catheter, restrictive clothing, leg bag straps, abdominal supports, orthoses)
See Also
References
- Gunduz H, Binak DF. Autonomic dysreflexia: an important cardiovascular complication in spinal cord injury patients. Cardiol J. 2012;19(2):215-9.