Autonomic dysreflexia is a potentially life-threatening medical emergency that affects people with spinal cord injuries. It is seen in spinal cord paralysis with T6 and higher level injuries . Rarely, autonomic dysreflexia may develop in T7 and T8 injuries. It is mostly a preventable and treatable condition. Knowing the person’s normal (basal) blood pressure level, trigger factors and symptoms is necessary for early recognition.

When autonomic dysreflexia develops, it must be recognized and intervened quickly, otherwise it may have serious consequences such as cerebral hemorrhage (stroke). Recognition of autonomic dysreflexia, which is a specific condition for spinal cord injury, can be difficult even for healthcare professionals who do not encounter these patients much. For these reasons, it is important for patients and their relatives to know the symptoms and what to do.

Symptoms

Symptoms include high blood pressure, throbbing headache, facial flushing, sweating above the injury level, goosebumps below the injury level, nasal congestion, nausea, low pulse (less than 60 beats per minute). Symptoms can vary from person to person.

Why Does It Happen?

Autonomic dysreflexia is triggered by a stimulus that disturbs the body below the level of spinal cord injury.

  • Bladder: Irritation of the bladder wall, urinary tract infection, obstruction of the catheter, or filling of the bladder.
  • Intestine: Enlargement or irritation of the bowel, constipation, stool plug formation, hemorrhoids, anal infection.
  • Skin cut, infection, pressure sore, ingrown nails, burns, squeezing of clothes.
  • It can also occur due to reasons such as sexual activity, menstruation, childbirth, ovarian cyst, stomach ulcer, colitis, peritonitis, fracture.
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Formation

Autonomic dysreflexia is caused by overactivation of the autonomic nervous system. The autonomic nervous system regulates the functions of our body, such as heartbeat, respiration, sweating, and digestion.

When there is a disturbing stimulus, nerve fibers carry this stimulus to the spinal cord. In the spinal cord, the signal goes up to the level of injury, but cannot be transmitted higher. Because the signals cannot reach the brain, the body cannot respond normally to this disturbing stimulus. A stimulus begins, which activates the sympathetic part of the autonomic system. Constriction of blood vessels and increase in blood pressure are observed.

Nerve receptors in the heart and blood vessels detect the increase in blood pressure and transmit this signal to the brain. The brain sends a signal to the heart, slowing the pulse, and the vessels above the injury level expand. Since the brain cannot send a signal below the level of injury, blood pressure cannot be regulated and the balance of the body is disturbed.

Treatment

When autonomic dysfunction is suspected, the first thing to do is to raise the head and sit upright at 90 degrees. Then, the clothes that can tighten the body should be loosened and unfastened and the blood pressure should be measured every five minutes.

Normal blood pressure of people with T6 and above spinal cord injuries is usually around 90-110 mmHg. A 20-40 mmHg higher than normal (baseline) value may be a sign of autonomic dysreflexia. A height of 15 mmHg above the normal value in children and 15-20 mmHg in young people may indicate this problem.

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The most important step in treatment is the elimination of the triggering cause. Bladder, bowel, skin, tight clothing, which are the most common causes, should be reviewed quickly. When the cause is eliminated, the symptoms may not disappear immediately, but may continue for a while.

If the cause cannot be determined or if the symptoms persist despite the suspected cause being eliminated, drug treatments are given. Various blood pressure lowering drugs can be used for this.

It is recommended that people with spinal cord injury carry a card describing their normal blood pressure values, injury levels, emergency contact phone numbers, and what to do in case of autonomic dysreflexia.

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