Autonomic Dysreflexia: Secondary Condition
by J. Glen House, MD
Spinal Cord Injury Secondary Condition: Autonomic Dysreflexia
What is it?
Autonomic dysreflexia (AD) is a very serious medical emergency that can be life threatening. It is a sudden increase in blood pressure, which if left untreated can lead to stroke or death.
Who gets it?
Autonomic dysreflexia can occur in individuals injured at the T6 (sixth thoracic) level and above. For example, it can occur in anyone who has a spinal cord injury from C1 to T6. There are cases that have been described at the level of T8, but it is questionable whether these cases were related to another cause of increased blood pressure.
What Causes Autonomic dysreflexia?
Autonomic dysreflexia is caused by a stimulus inside or outside the body that would normally be removed, adjusted or changed. It used to be described as a stimulus that would be considered painful or annoying, but it has been shown to occur with sexual stimulation as well. Therefore, any type of increased stimulation can lead to autonomic dysreflexia and require intervention or removal of the stimulus.
Autonomic dysreflexia and the Skin
• Sitting or lying in one position for a prolonged period of time causes the able-bodied person to shift their weight or change positions. For example, when the able-bodied person sits in a car or chair in a movie for too long, they automatically change their position, relieving the pressure and discomfort. Most people do this without even being aware of it. After a spinal cord injury, the sensation of discomfort is minimalized or absent; this warning sign of skin protection is no longer present. Therefore, autonomic dysreflexia can occur in this situation and frequent changes in position to relieve pressure on the skin are mandatory.
• Pressure ulcers (skin breakdown or bedsores) can cause a continuous stimulation of pain or discomfort. Patients should avoid having direct pressure on pressure ulcers which may decrease or eliminate autonomic dysreflexia.
• Clothing that is too tight
• Urinary collection bags with tight leg straps
• Sunburns are common and frequent causes of autonomic dysreflexia. Sunburns can be painful for a prolonged period of time which makes management of autonomic dysreflexia difficult because of the constant prolonged painful stimulation. Therefore, precautions should be taken, including use of sunscreen and limiting time with direct sun exposure.
• Touching hot objects to skin that has limited or no sensation can quickly lead to burns, which are obviously dangerous.
• Neuromuscular electrical stimulation is occasionally used with the rehabilitation patient. This simulation can be enough to lead to autonomic dysreflexia. Therefore, if electrical stimulation is used in individuals with spinal cord injury at T6 or above, initially blood pressure should be measured to evaluate for an increase in blood pressure in relationship to its use.
