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Autonomic dysreflexia

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Trained carers who look for the signs of an imminent attack

Autonomic dysreflexia, also known as hyperreflexia, means an over-activity of the autonomic nervous system causing an abrupt onset of excessively high blood pressure. Persons at risk for this problem generally have injury levels above T-5.

Autonomic dysreflexia (AD) can develop suddenly and is potentially life threatening and is considered a medical emergency. If not treated promptly and correctly, it may lead to seizures, stroke, and even death.

AD occurs when an irritating stimulus is introduced to the body below the level of spinal cord injury, such as an overfull bladder. The stimulus sends nerve impulses to the spinal cord, where they travel upward until they are blocked by the lesion at the level of injury. Since the impulses cannot reach the brain, a reflex is activated that increases activity of the sympathetic portion of autonomic nervous system. This results in spasms and a narrowing of the blood vessels, which causes a rise in the blood pressure.

Signs and symptoms of autonomic dysreflexia

Helping Hands carers are trained to look out for the signs of an imminent attack:

  • Pounding headache (caused by the elevation in blood pressure)
  • Goose pimples
  • Sweating above the level of injury
  • Nasal congestion
  • Slow pulse
  • Blotching of the skin
  • Restlessness
  • Flushed (reddened) face
  • Red blotches on the skin above level of spinal injury
  • Sweating above level of spinal injury
  • Nausea
  • Cold, clammy skin below level of spinal injury

Causes of autonomic dysreflexia

Samantha Atkins, Clinical Nurse Manager at Helping Hands comments, “Autonomic dysreflexia can be a potentially life-threatening medical emergency which can affect people with spinal cord injuries, there are a few key warning signs which can range from a pounding headache, flushed rosy face, sweating above the level of the injury, a feeling of intense sickness or nausea, nasal congestion and stuffiness, another key sign can also be goose bumps and a very slow pulse – usually around 60 beats per minute or slower.”

“One of the most common causes is an irritation of the bladder wall, a UTI (urinary tract infection), an overfilling of the bladder, blocked catheter or overfilled drainage bag, people suffering with AD could also have bladder spasms, or possibly even stones in the bladder.”

“The second most common cause is a bowel that is full of stool, one that is constipated or impacted or full of gas. It’s important to note that any stimulus to the rectum, such as digital stimulation, can trigger a reaction, leading to autonomic dysreflexia. Other causes can include skin irritations, cuts, bruises, wounds, pressure sores, burns (including those from hot water and even sunburn), broken bones, pregnancy, ingrown toenails, appendicitis, and other medical complications.”

Samantha added, “Recognising the symptoms of AD and knowing how to act is key, at risk individuals should know their baseline blood pressure and ensure that this is written within the care plan – Helping Hands carers are expertly trained to manage a range of situations and will know and act when something appears out of the ordinary. When they join the team they go through a three to five day full training programme based on their level of experience, designed to give them the theory and the practical skills to provide the best quality home care in the industry. Our carers are also coached and mentored on the job by our live-in care managers and supported by our clinical team. Our carers are passionate, dedicated and fully committed to caring for individuals in their own home.”

Autonomic Dysreflexia FAQs

Autonomic Dysreflexia is the sudden onset of excessively high blood pressure that occurs in people with spinal cord injuries.

Autonomic dysreflexia occurs when something happens to your body below the level of injury. This can be a pain, irritant or a normal function that your body may not notice.

Autonomic dysreflexia is caused by an irritant below the level of injury, including the bladder: irritation of the bladder wall, urinary tract infection, blocked catheter or overfilled collection bag.; the bowel: distended or irritated bowel, constipation or impaction, haemorrhoids or anal infections.

To prevent autonomic dysreflexia, it is worth maintaining continence care, whilst also not placing any unnecessary stress on the spine.

Autonomic dysreflexia may occur within the weeks to years after experiencing a spinal cord injury. Most people at risk develop their first episode within 12 months after injury.


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Page reviewed by Samantha Atkins, Regional Clinical Lead on February 2, 2021

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