The condition of autonomic dysreflexia (AD) affects some people who have suffered a spinal cord injury at or above the sixth thoracic vertebra (T6). Whenever the autonomic nervous system overreacts to a stimulus below the level of injury, it results in involuntary functions such as blood pressure, heart rate, and sweating. A sudden and severe increase in blood pressure can lead to a stroke, heart attack, or other complications.
Nerves below the level of the SCI are irritated or stimulated, causing AD. A full bladder or bowel, a urinary tract infection, a kidney stone, a pressure sore, an ingrown toenail, tight clothing, sexual activity, or even a change in temperature can cause this. In the damaged spinal cord, a signal is sent to the brain, but it is blocked. As the brain cannot send a message back to lower the blood pressure, the body responds by constricting the blood vessels below the injury, which raises the blood pressure even more.
The most common symptom of AD is a pounding headache, which is caused by the high blood pressure. Other symptoms may include:
Blurred vision or spots in front of the eyes
Flushed face or red blotches on the neck and chest
Sweating above the level of the injury
Goosebumps or chills below the level of the injury
Nasal congestion or stuffy nose
Nausea or vomiting
Anxiety or feeling of doom
Slow or irregular heartbeat
A blood pressure reading of 20 to 40 mmHg above the normal level for the person is considered a sign of AD. AD is diagnosed by measuring blood pressure and trying to determine the cause of the stimulus. IBS patients may have a lower baseline blood pressure than the average, so it is important to monitor their blood pressure regularly and know their baseline blood pressure. The source of the irritation or stimulation may be determined by a physical examination and tests such as urine analysis, X-rays, or ultrasound.
The first step in treating AD is to sit up or raise the head of the bed up to 90 degrees, which will increase blood flow to the lower body. This reduces the blood pressure. The next step is to remove or treat the cause of the stimulus, such as emptying the bladder or bowel, loosening tight clothing, or applying a local anesthetic to a wound. The blood pressure can be lowered with medication if these measures do not work. Until the blood pressure returns to normal and the symptoms subside, the person should be monitored.
The best way to prevent AD is to avoid or minimize the triggers that can cause it. This includes:
Following a regular bladder and bowel program to prevent overfilling or constipation
Checking the skin for pressure sores, infections, or injuries and treating them promptly
Keeping the nails trimmed and clean to prevent ingrown toenails or cuts
Wearing loose and comfortable clothing and avoiding belts, straps, or elastic bands that can constrict the abdomen or legs
Maintaining a comfortable temperature and avoiding exposure to extreme heat or cold
Practicing safe and hygienic sexual activity and using lubricants or condoms to prevent irritation or infection
Educating oneself and others about the signs and symptoms of AD and how to manage it
In the absence of prompt and appropriate treatment, AD can have severe consequences. It can be controlled and managed with awareness, prevention, and prompt action. For more information and guidance about AD, people with SCI should speak with their healthcare providers.
