Spinal Cord Injury: Autonomic Dysreflexia

Topic Overview

Autonomic dysreflexia is a syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above).

Be prepared to call your spinal cord injury therapist, 911, or other emergency services if you or the person with the spinal cord injury (SCI) has the symptoms of autonomic dysreflexia. If you or a caregiver cannot treat it promptly and correctly, it may lead to seizures, stroke, and even death. Symptoms include:

• A pounding headache.
• A flushed face and/or red blotches on the skin above the level of spinal injury.
• Sweating above the level of spinal injury.
• Nasal stuffiness.
• Nausea.
• A slow heart rate (bradycardia).
• Goose bumps below the level of spinal injury.
• Cold, clammy skin below the level of spinal injury.

If you feel you have autonomic dysreflexia:

• Sit up straight, or raise your head so you are looking straight ahead. If you can lower your legs, do so. You need to be sitting upright until your blood pressure is back to normal.
• Loosen or take off any tight clothing or accessories. This includes braces, catheter tape, socks or stockings, shoes, and bandages.
• Empty your bladder by draining your Foley catheter or using your catheter.
• Use digital stimulation to empty your bowel.
• Check your skin for red spots that mean you might have a pressure injury.
• If possible, check your blood pressure every 5 minutes to see if it improves.
• Call your doctor, even if symptoms go away and your blood pressure is decreasing.
• If the symptoms return, repeat the above steps and go to the emergency room or call emergency services.

Autonomic dysreflexia occurs when something happens to your body below the level of your injury. This can be a pain or irritant (such as tight clothing or something pinching your skin) or a normal function that your body may not notice (such as having a full bladder and needing to urinate). These situations trigger an automatic reaction that causes your blood pressure to go up. As your blood pressure goes up, your heartbeat slows and may become irregular. Your body cannot restore your blood pressure to normal because of your spinal cord damage. The only way to return things to normal is to change the situation-for example, by removing tight clothing or emptying your bladder.

The following are some frequent causes of autonomic dysreflexia and how you can prevent them.

How to prevent autonomic dysreflexia

Cause	Prevention
Overfull bladder Urinary tract infections (UTIs)	Follow your bladder management program.
Overfull bowel or constipation Gastrointestinal problems such as gallstones, stomach ulcers, or gastritis	Follow your bowel management program. Eat fiber and consume fluids as your doctor suggests.
Pressure injuries Ingrown nails Other skin problems	Check your skin daily. Make sure all clothing or devices fit correctly.
Sexual activity	Be aware that sexual activity can cause the condition. Discuss this with your doctor.
Broken bones or other injuries Tight clothing or devices Extreme temperatures or quick temperature changes	Be aware that these can cause the condition. Discuss this with your doctor. Make sure all clothing and devices fit correctly.