If you or a caregiver cannot treat it promptly and correctly, it may lead to seizures, stroke, and even death. Symptoms include:. If you feel you have autonomic dysreflexia :. Autonomic dysreflexia occurs when something happens to your body below the level of your injury. This can be a pain or irritant such as tight clothing or something pinching your skin or a normal function that your body may not notice such as having a full bladder and needing to urinate.
These situations trigger an automatic reaction that causes your blood pressure to go up. As your blood pressure goes up, your heartbeat slows and may become irregular. Your body cannot restore your blood pressure to normal because of your spinal cord damage.
The only way to return things to normal is to change the situation—for example, by removing tight clothing or emptying your bladder. The following are some frequent causes of autonomic dysreflexia and how you can prevent them. Author: Healthwise Staff. This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use and Privacy Policy.
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Top of the page. Topic Overview Autonomic dysreflexia is a syndrome in which there is a sudden onset of excessively high blood pressure. In addition, inappropriate activation of the sympathetic nervous system, which is associated with AD, occurs several times a day and could be asymptomatic in spite of the significantly elevated arterial BP [ 9 , 24 ].
Thus, it is necessary to diagnose such asymptomatic AD earlier on and apply appropriate treatment interventions. In this present study, although the risk of morbidity from heart disease or cerebral vascular disease in Therefore, it is suggested that, as a preventive measure for cardiovascular disease in patients with cervical and upper thoracic SCI, early diagnosis and therapeutic interventions for AD are required using ABPM in the early stage. Medical personnel, caregivers, and individuals with SCI should be aware of the importance of the timely diagnosis and management of this life-threatening condition, which can result in a variety of significant complications including stroke, seizures, myocardial ischemia, and death [ 25 ].
It has been reported that the prevalence of AD increases according to the level and severity of SCI [ 20 , 26 , 27 ]. This differs from the previous report on the prevalence of AD in incomplete injury, because the previous report was about the prevalence of AD during the urodynamic study in chronic SCI patients. Moreover, in the intergroup comparison, significant differences in daytime, nighttime, and hour SBP were observed, in which AD occurred more frequently in the motor complete group with a concomitant increase in the number of AD events.
The timing of AD onset is not yet clear. These results suggest that patients with acute and subacute SCI were not diagnosed early and did not receive appropriate treatment for AD. Moreover, the relationships between the level and severity of injury and the timing of AD onset are currently not clear.
The subacute group showed a significant difference in the daytime and nighttime SBP with a concomitant loss of nocturnal BP dipping and a significant decrease in the nighttime HR. However, the chronic group showed no significant differences in nocturnal BP dipping and HR. Considering the report that significant morphological changes such as atrophy of sympathetic preganglionic neurons and loss of dendritic arbors were observed in the acute phase [ 30 ], it is believed that neural regeneration-mediated recovery of the autonomic nervous system by passage of time or acclimatization of patients to the stimuli and symptoms, which cause AD and acquisition of self-control ability [ 9 ], influenced the above results.
Limitations of this study were 1 the small sample size of the subjects, 2 the incomplete exclusion of causes that may induce AD, and 3 the fact that although the relationship between activities and AD onset was analyzed by recording activities of daily living in the daytime, the application of this type of evaluation, which is based on the record of patients or caregivers, is limited due to its lack of accuracy. Therefore, additional research addressing these limitations is necessary. The results of this study showed that the incidence rate of AD was To manage long-term cardiovascular diseases and to lower mortality in patients with SCI, aggressive diagnosis and therapeutic interventions for AD using ABPM in the early stage should be considered even in asymptomatic patients.
This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview. Special Issues. Academic Editor: Antonio Salgado. Received 21 Jul Accepted 03 Oct Published 26 Oct Abstract Objective.
Introduction Autonomic dysreflexia AD is a disease that commonly occurs in patients with spinal cord injury SCI , especially in the cervical and upper thoracic level above T6 [ 1 , 2 ].
Methods 2. Subjects The subjects of this study were patients with SCI who were admitted to the rehabilitation department of Wonkwang University Hospital. Results 3. General Characteristics of the Subjects The study included 22 men and 6 women with a mean age of range: 31—77 years.
Table 1. General characteristics of patients with spinal cord injury. Table 2. Table 3. Table 4. Table 5. References C. Mathias and H. Teasell, J.
Arnold, A. Krassioukov, and G. Yarkony, R. Katz, and Y. View at: Google Scholar Z. Pine, S. Miller, and J. Eltorai, R. Kim, M. Vulpe, H. Kasravi, and W. Benito, E. Autonomic dysreflexia during urodynamics. Spinal Cord. Autonomic dysreflexia: incidence in persons with neurologically complete and incomplete tetraplegia. Prevalence and etiology of autonomic dysreflexia in children with spinal cord injuries. Blood pressure and age associated with silent autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury.
Epub Dec Karlsson AK. Autonomic dysreflexia. Silent autonomic dysreflexia during a routine bowel program in persons with traumatic spinal cord injury: a preliminary study. Arch Phys Med Rehabil. Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity. A systematic review of the management of autonomic dysreflexia after spinal cord injury.
Prevalence of autonomic dysreflexia in patients with spinal cord injury above T6. Biomed Res Int. Epub Oct Silent autonomic dysreflexia during voiding in men with spinal cord injuries. J Urol. Iatrogenic urological triggers of autonomic dysreflexia: a systematic review. Epub Mar Paroxysmal sympathetic hyperactivity: the storm after acute brain injury. Lancet Neurol.
Erratum in: Lancet Neurol. J Neurosci. Epub Apr 2. Autonomic dysreflexia: pharmacological management of hypertensive crises in spinal cord injured patients. A review of paroxysmal sympathetic hyperactivity after acquired brain injury. Ann Neurol. Prog Urol. Epub Mar 7. Latest approaches for the treatment of spasticity and autonomic dysreflexia in chronic spinal cord injury. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury.
Autonomic dysreflexia after spinal cord injury: central mechanisms and strategies for prevention. Prog Brain Res. Autonomic dysreflexia causes chronic immune suppression after spinal cord injury. Reeve Foundation. What is autonomic dysreflexia? Comparisons of some of the functions of the Sympathetic and Parasympathetic Nervous Systems: Autonomic dysreflexia AD is an issue in the autonomic nervous system.
Those at Risk for Autonomic Dysreflexia Individuals with injury from disease or trauma to the upper motor nerves are at risk for autonomic dysreflexia.
Diagnosing Autonomic Dysreflexia Detecting the presence of AD is performed through assessment of blood pressure. Triggers for Autonomic Dysreflexia The detection of AD has been classically noted to be due to a trigger that stimulates the body into an AD episode. The bladder is the primary documented source of triggering AD episodes. Most often the cause is something that is not allowing urine to pass out of the body leading to bladder overdistention.
This can range from a kink in a catheter, clogged catheter, bladder spasms, detrusor sphincter dyssynergia DSD, the bladder and sphincter not working in unison , stones, infection, or other constrictions.
For some, intermittent catheterization or suprapubic catheters can be an irritant. Bladder testing through cystoscopy a scope inserted into the bladder , urodynamic testing assessment of bladder function , shock-wave lithotripsy breaking up stones can also trigger AD. Equipment that is used for urine containment such as leg bag straps that are too tight or a heavy or overfull leg bag, wet urine containment undergarments, or external catheter straps are also culprits. The second most frequent trigger of AD is the bowel.
Bowel overdistention from swift movement, an incomplete or lack of a bowel program, impaction, constipation, gas, regular or overzealous digital stimulation, enemas, or manual removal are all triggers.
Skin issues are the third most common trigger of AD. Skin issues cover a wide range from an itch that cannot be sensed or scratched, rashes, pressure injury at any stage, cuts, bruises, bone fractures, ingrown toenails, overly long toenails, sitting on a wrinkled sheet, even just an air current blowing over the fine hairs of your arm or leg. Constrictive clothing that is too tight, lumpy, or baggy, rivets on jeans, shoes that fit incorrectly, socks too tight in the toes or leg, belts, bras, the list of clothing issues is constantly increasing.
Sexual function and interaction, menstruation, pregnancy, delivery, sperm retrieval Deep vein thrombosis DVT formation of a blood clot in a deep vein , pulmonary embolism PE Heterotrophic ossification HO presence of bone in soft tissue where it is not usually found Orthostatic hypotension OH blood pressure drops when sitting or standing Pain Eye effects from computer use or bright sunshine Treatment for Autonomic Dysreflexia AD is a medical emergency.
When AD symptoms are noted, start by first quickly sitting bolt upright. Your torso and hips should be at a degree angle. Have someone help you to a sitting position if you are unable to do this yourself. The sudden change from laying to sitting takes advantage of orthostatic hypotension when your blood pressure suddenly drops as the blood vessels cannot constrict to rush blood to your head fast enough. Continue to monitor blood pressure every minutes until it returns to your normal. Loosen anything tight or restrictive on your body while getting into the sitting position.
Look for the cause of this episode of AD. Start with checking the three most common triggers for AD. Check urine flow. Catheterize if necessary if there is no or little urine output. Then check the bowel for blockage. Disimpact the bowel if stool is present. Then check the skin removing wrinkles, constrictions or tight clothes. You may know your triggers from previous AD episodes.
Correction of your usual trigger source is a good start if you are aware of it. If AD does not start to resolve with corrections, continue to look for and remove triggers below the level of injury. If you have medication prescribed for AD administer it. Medication may consist of an antihypertensive with rapid onset and short duration.
Reapply if needed. Wash off the Nitro paste when blood pressure is stable to avoid lowering blood pressure too much. Nifedipine if Nitro paste is NOT available — 0. This may be repeated every min as needed. IV antihypertensives may be administered only in a monitored setting I. Other medications used to treat ongoing and dangerous AD episodes include nifedipine, nitrates, captopril, terazosin, prazosin, phenoxybenzamine, prostaglandin ED and sildenafil.
Selection of the correct medication for you should be made in consultation with your healthcare professional. Autonomic Dysreflexia Video A video explaining the cause and treatments for Autonomic Dysreflexia from the Reeve Foundation can be viewed here. Rehabilitation for Autonomic Dysreflexia You will need to be involved with identification of AD episodes.
Research Traditionally, research about causes and treatments for autonomic dysreflexia has focused on the individual trigger such as tone spasms , pressure, bladder, and bowel issues.
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