Autonomic Dysreflexia

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KEY POINTS

• Autonomic dysreflexia happens after a spinal cord injury to the upper back or neck areas. When the spinal cord nerves are cut or torn, the nerves cannot carry signals to and from your brain and other parts of your body. This can cause dangerous symptoms elsewhere in the body.
• Autonomic dysreflexia is a medical emergency and can be life-threatening. You should get help right away from emergency healthcare providers or from a care giver or family member who has knowledge and experience to help you.
• Keep medical alert information with you to let caregivers or emergency helpers know that you have autonomic dysreflexia. Keep a diary of symptoms and discuss this information with your healthcare provider.

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What is autonomic dysreflexia?

Autonomic dysreflexia happens after a spinal cord injury to the upper back or neck areas.

Your spinal cord is a bundle of nerves that runs down the middle of your back. It is protected by the bones of your spine called vertebrae. Your spinal cord carries signals between your body and your brain. When the spinal cord nerves are cut or torn, the nerves cannot carry signals to and from your brain and other parts of your body. This can cause dangerous symptoms elsewhere in the body.

The autonomic nervous system is the parts of your brain and spine that control your body’s functions without you thinking about them, such as:

• Breathing
• Beating heart
• Controlling blood pressure
• Digesting food

Autonomic dysreflexia is also called autonomic hyperreflexia.

What is the cause?

Pain, pressure, or other irritation on any part of your body triggers nerve signals. Normally, the brain receives the nerve signals and controls your body’s responses. But with autonomic dysreflexia, the injured spinal cord does not let the nerve signals travel on the normal pathways to and from the brain. Instead, the nerve signals cause a dangerous rise in blood pressure, and then a slow heart rate.

These nerve signals may be triggered by:

• A full bladder
• Pressure on the skin from tight clothing
• Cuts, scrapes, or burns
• Pressure ulcers, also called bed sores
• Constipation
• Bladder infection
• Menstrual cramps

What are the signs and symptoms?

The signs and symptoms include:

• Rise in blood pressure
• Flushing
• Sweating
• Headache
• Anxiety
• Vision changes
• Nasal stuffiness
• Chills or goose bumps
• Slow heart rate

How is it diagnosed?

A healthcare provider will ask about your symptoms and medical history and examine you.

How is it treated?

Autonomic dysreflexia is a medical emergency and can be life-threatening. You should get help right away from emergency healthcare providers or from a caregiver or family member who has knowledge and experience to help you. You should be checked for:

• Tight clothing, sore spots on your skin, and proper seat cushions if you are in a wheel chair
• A full bladder, including proper position and drainage of your catheter if you have one
• Constipation and bowel impaction, including diarrhea, nausea, or vomiting
• Injuries, redness, or swelling anywhere on your body

You should stay in a sitting position while waiting for help. You should have blood pressure checks every 5 minutes.

Call for emergency services. Do not drive yourself if you need help.

How can I take care of myself?

• Follow the exercise or rehabilitation treatment plan your healthcare provider prescribes. You may need to do special exercises to keep muscles as strong as possible. Therapy may include skin care to avoid pressure sores, and training to help you care for your bladder and bowels.
• Keep a diary of symptoms and triggers, and discuss this information with your healthcare provider.
• If your spinal cord injury has affected your ability to chew or swallow or have a bowel movement, you may need to make some changes in your diet to stay healthy and prevent diarrhea and constipation. Ask your provider about the benefits of talking to a dietitian to learn what foods you should include in your diet.
• Drink enough liquids each day to keep your urine light yellow in color.
• You may need help with daily activities or you may need round-the-clock help and care.
• Consider counseling. Counseling can help you cope with stress, frustration, depression, and other emotions. Counseling can help you and your family adjust to living with a spinal cord injury.
• Join a support group. Support groups can help by sharing common concerns and solutions to problems with others in the same situation.
• Keep medical alert information with you to let caregivers or emergency helpers know that you have autonomic dysreflexia. Keep an up-to-date record of your level of injury, your normal blood pressure, your medicines, and emergency phone numbers.