Autonomic Dysreflexia


Autonomic_dysreflexia5aThe signs of AD include:

  • Pounding headache, flushed face
  • Sweating above the level of the spinal injury
  • Nasal stuffiness, nausea
  • Slow pulse, lower than 60 beats per minute
  • Goose flesh below the level of the spinal injury

What to do if AD is suspected:

    1. The first thing to do if AD is suspected is to sit up, or raise your head to 90 degrees.

IMPORTANT: Stay sitting up until blood pressure is normal.

  1. If you can lower your legs, do so.
  2. Next, loosen or remove anything tight.
  3. Most importantly, notify your doctor or other appropriate expert, so that whatever is causing the problem can be located and removed or treated.

Important: Even if you believe you have identified and resolved the problem, it is important to get the situation checked, in case further action is necessary.

Autonomic Dysreflexia (or AD for short) is unique to spinal cord injuries.

What is AD?

  • It is a sudden and dangerous rise in blood pressure triggered by an exaggerated response to painful stimuli, below the level of spinal cord damage
  • If AD is not treated or the cause remains unresolved, then it could be fatal
  • AD can happen any time from the start of spinal paralysis. It happens in both complete and incomplete injuries but usually only affects those with an injury at the level T6 and above

ad-imageWhat happens to the body during an episode of AD?

  • severe pounding headache
  • flushed appearance of the skin above the level of injury
  • profuse sweating above the level of the lesion
  • nasal congestion
  • feeling unwell
  • blurred vision
  • increase in spasm
  • continued severe hypertension (raised blood pressure)

Common causes of Autonomic Dysreflexia (AD)

  • blocked catheter
  • constipation
  • a broken bone
  • ingrowing toenail
  • pressure ulcer
  • erection
  • menstrual problems
  • pregnancy/labour

Treatment of Autonomic Dysreflexia (AD)

AD needs to be treated urgently because it can be fatal. It is important to find and treat the cause as soon as possible.

First things to do are:

  • treat the high blood pressure whilst identifying the cause
  • sit up to lower the blood pressure
  • check for possible causes so that the pain stimulus can be removed
  • if the pain stimulus cannot be removed take 10mg Nifedipine under the tongue. (Nifedipine patches are available and can be removed when the symptoms are relieved)
  • seek prompt medical advice if the cause cannot be identified or the blood pressure cannot be controlled