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Signs of Autonomic Dysreflexia and How to Treat Them

It’s important to be aware of the signs of autonomic dysreflexia because they affect major body functions like blood pressure and heart rate.

During autonomic dysreflexia, the autonomic nervous system overreacts to stimulation below the level of injury, which results in a sudden spike in blood pressure and other involuntary functions.

If not properly managed, autonomic dysreflexia can be life-threatening. Luckily, it can be fairly simple to avoid, if you know what signs to look for.

This article will give you a comprehensive overview of the signs of autonomic dysreflexia and how to treat them.

Autonomic Dysreflexia and Spinal Cord Injury

Autonomic dysreflexia is a common condition that can occur in individuals with spinal cord injury when there’s irritation below one’s level of injury.

However, not all spinal cord injury patients experience autonomic dysreflexia. Individuals with T6 spinal cord injuries and higher are typically at risk for this condition, although it can rarely occur with T7 or T8 injuries as well. Noxious stimulation below your level of injury can set off a reflex that causes the blood vessels to constrict, resulting in increased blood pressure.  

Usually, the brain will send messages throughout the body to inform you of what the noxious stimulus is so that you can remove it. At this point when the stimulus is removed, the brain would typically send signals to relax the blood vessels and reduce blood pressure. However, after a spinal cord injury, messages from the brain may be unable to reach areas below one’s level of injury, therefore not allowing the body to return to it’s normal state.

As a result, your body stays in this state of dysreflexia (until the noxious stimulus is removed), putting you at risk for other serious conditions such as brain injury, stroke, seizures, organ failure, and even death.

Now that you understand why autonomic dysreflexia occurs after spinal cord injury, let’s discuss what triggers it.

Autonomic Dysreflexia Causes

Nearly anything that bothers areas below one’s level of injury can cause autonomic dysreflexia.

It’s not yet understood why some people experience autonomic dysreflexia more often than others, but all higher-level spinal cord injury patients should be aware of what can trigger the autonomic nervous system to overreact.

Common causes of autonomic dysreflexia include:

  • Full bladders or blocked/full catheter bags
  • Constipation or distended bowels
  • Skin irritations (burns, cuts, bruises, pressure sores, etc.)
  • Extreme temperatures
  • Tight clothing
  • Any sort of pressure on the body
  • Menstrual cramps
  • Sexual activity

Individuals with autonomic dysreflexia need to be vigilant in looking for these triggers and try to avoid them as much as possible.

However, sometimes individuals are unaware of triggers and signs of autonomic dysreflexia may occur.

Signs of Autonomic Dysreflexia

headache is often one of the first signs of autonomic dysreflexia

While the most common sign of autonomic dysreflexia is a sudden increase in systolic blood pressure (the first/top number of your blood pressure that measures the pressure in your arteries when your heart beats), there are many other ways the autonomic nervous system can react.

Depending on the severity of injury, level of injury, and pre-existing health complications, everyone experiences autonomic dysreflexia a little differently.

Common signs of autonomic dysreflexia include:

  • Sudden rise in systolic blood pressure (typically 20-40 mm Hg above baseline in adults)
  • Sweating
  • Flushed or blotchy skin
  • Slow heart rate
  • Severe Headaches
  • Anxiety or feelings of a panic attack
  • Blurry vision
  • Goosebumps
  • Tightness or pressure in the chest
  • Stuffy nose

In the following section, we’ll review what SCI patients should do if they notice signs of autonomic dysreflexia.

How to Treat Signs of Autonomic Dysreflexia

patient with t6 spinal cord injury learning how to manage autonomic dysreflexia

Often, spinal cord injury patients can manage their autonomic dysreflexia by avoiding triggers and staying alert for early signs.

If patients notice a sudden rise in blood pressure or any other signs of autonomic dysreflexia, they should make sure to immediately sit upright, lower their legs, and keep their heads raised to help lower their blood pressure.

After that, it is crucial to identify what is triggering the reaction. Generally, autonomic dysreflexia will subside after the trigger is removed.

Some of the best practices for treating autonomic dysreflexia include:

  • Emptying the bowel and bladder regularly
  • Checking for clogs or kinks in catheters
  • Wearing looser clothing (but not too loose because the excess fabric can bunch up)
  • Avoiding hard or sharp objects in clothing that can rub again the skin such as zippers and pins
  • Inspecting the skin daily for pressure sores, bruises, or other signs of irritation
  • Avoiding extreme temperatures
  • Applying topical treatments like lidocaine gel and nitroglycerin paste that can help reduce hypertension and irregular heartbeats

After taking the necessary actions to relieve signs of autonomic dysreflexia, individuals should use a blood pressure cuff every 5-10 minutes to ensure that their blood pressure is stabilizing.  

If symptoms do not subside, individuals should seek immediate medical attention.

Understanding Autonomic Dysreflexia: Key Points

Autonomic dysreflexia is most common in individuals with T6 or higher level spinal cord injuries.

Because messages from the brain cannot reach areas below the level of injury, major body functions like blood pressure, heart rate, and temperature regulation can be disrupted.

Therefore, it is essential to be alert for potential triggers and signs of autonomic dysreflexia to prevent symptoms from progressing. Additionally, in order to know if your blood pressure has spiked, it’s important to be aware of what your baseline blood pressure range typically is.

Hopefully, this article helped you better understand what autonomic dysreflexia is and how to manage it. Good luck!

Photos from top to bottom: iStock/humonia/Ridofranz/KatarzynaBialasiewicz

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