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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
  • Hypertension (blood pressure greater than 200/100)
  • Flushed (reddened) face
  • Red blotches on the skin above level of spinal injury
  • Sweating above level of spinal injury
  • Nausea
  • Slow pulse (less than 60 beats per minute)
  • Cold, clammy skin below level of spinal injury

Causes of autonomic dysreflexia

Mel Dawson, head of Clinical at Helping Hands comments, “There can be many stimuli that cause autonomic dysreflexia. Anything that would have been painful, uncomfortable or physically irritating before the injury may cause autonomic dysreflexia after the injury.

“The most common cause seems to be overfilling of the bladder. This could be due to a blockage in the urinary drainage device, bladder infection (cystitis), inadequate bladder emptying, bladder spasms, or possibly stones in the bladder.

“The second most common cause is a bowel that is full of stool or gas. Any stimulus to the rectum, such as digital stimulation, can trigger a reaction, leading to autonomic dysreflexia. Other causes include skin irritations, wounds, pressure sores, burns, broken bones, pregnancy, ingrown toenails, appendicitis, and other medical complications.”

Mel added, “Helping Hands carers are trained to deal with these situations and have access to regional managers, training and our specialist teams at all times.”

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