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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

Carole Kerton-Church

Carole Kerton-Church, Regional Clinical Lead at Helping Hands comments: “Autonomic Dysreflexia or AD affects people with a spinal cord injury which has occurred above the T6 vertebrae. It can be a life-threatening condition requiring urgent intervention as if left untreated it can result in stroke, seizures, or cardiac arrest.

“The most common triggers for AD are usually related to the bladder or bowel. If the bladder is overfull due to a blocked catheter or overfull drainage bag, or there are bladder stones, an infection or a bladder spasm which can occur during a routine catheter change, any of these can potentially trigger an AD episode. Likewise, constipation, trapped gas, or faecal impaction in the bowel or even the stimulation that occurs during routine bowel management can be a trigger for autonomic dysreflexia. Therefore, bladder and bowel management are such important aspects of spinal injury care. Other triggers can include wounds, pressure sores, tight clothing, ingrown toenails, menstruation, child birth, insect bites, sunburn, scalds or any other medical complications, in fact anything that can cause a painful stimulus below the level of the spinal cord injury.”

Carole added: “Early recognition of the symptoms is vital. Helping Hands carers are trained by the Clinical Lead Nurses to identify the signs of autonomic dysreflexia: facial flushing, pounding headache, cold clammy skin, goosebumps, sweating, blurred vision, stuffy nose, and nausea. Carers are able to support the customer by identifying and removing the cause where possible and administering any rescue medication such as GTN spray if needed. Our carers will work with our Clinical Lead Nurses to reduce the risks of AD as much as possible. This includes following a robust bladder and bowel management routine along with bespoke care planning and risk assessments.”

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 Deanna Lane, Senior Regional Clinical Lead on October 15, 2021

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