Preventing Secondary Conditions – Autonomic Dysreflexia

Among the secondary conditions that people with spinal cord injuries experience, one of the most life-threatening is autonomic dysreflexia. Autonomic dysreflexia is the body’s response to a miscommunication between the sympathetic autonomic nervous system and the parasympathetic autonomic nervous system, and can cause a super quick spike in blood pressure, which can ultimately lead to a stroke. A tell-tale sign of autonomic dysreflexia is a sudden, splitting headache.

This condition can be hard to understand, let alone explain to family members and medical professionals. To understand exactly what autonomic dysreflexia is so you can protect yourself from life-threatening episodes, read on for a thorough explanation of this secondary condition.

What Exactly is Autonomic Dysreflexia (AD)?

When there is damage to the spinal cord, the signals traveling up the spinal cord can’t reach the brain, which causes miscommunication between the sympathetic and parasympathetic autonomic nervous systems. This can cause many disruptions to the body.

There are still a myriad of signals happening in the lower part of your body after a SCI. Just because you cannot feel them doesn’t mean that various nervous signals are still active. For example, even if you don’t have bladder or bowel control, the nerve signals between the bladder and bowel in your body are still communicating. And when there is pain felt anywhere below the level of injury, those nerve signals travel up the spinal cord and stop at the site of injury, which unfortunately stimulates the autonomic nervous systems.

When this occurs, the body is unable to prevent nerve signal symptoms coming from the pain trigger. It is up to you to remove the cause of the autonomic dysreflexia as soon as you can so that the symptoms subside. In simpler terms: you must find what is causing the autonomic episode dysreflexia ASAP. We will discuss the causes of AD in detail below.

Who Can Get It?

People who have quadriplegia and paraplegia are susceptible to autonomic dysreflexia. Those with paraplegia at the T5 level or above are at most risk of this condition—some with lower injuries have reported experiencing AD, as well.

Signs of AD

Since autonomic dysreflexia can happen suddenly, the signs and symptoms for this condition also present suddenly. The good news is that the signs of autonomic dysreflexia are easy to spot. Here are the signs and symptoms to look for if autonomic dysreflexia is occuring:

– Hypertension: any blood pressure that is greater than 200/100

– Pounding headache

– Flushed face

– Sweating above the level of injury

– Goose flesh below the level of injury

– Nasal stuffiness

– Nausea

– Slow pulse: slower than 60 beats per minute

– Cold or clammy skin

– Red blotches on the skin above the level of injury

– Confusion and/or dizziness

– Dilated pupils

– Anxiety and apprehension

When you experience a variety of these symptoms together, it is likely autonomic dysreflexia. Keep a blood pressure cuff at your house so you can know your baseline blood pressure (usually in the 90-110 mm Hg range). When you experience autonomic dysreflexia, you’ll know when your blood pressure is no longer in your baseline and increases by 20 mm Hg or above.

Causes of AD

While there are several causes of autonomic dysreflexia, there are several causes you should always check for first. The most common cause of autonomic dysreflexia is bladder-related. A clogged or kinked catheter, an over-full catheter bag, a urinary tract infection, or a bladder stone can cause autonomic dysreflexia. Remember, any pain that is below the level of injury will present itself via autonomic dysreflexia.

Bowel-related autonomic dysreflexia can be caused by constipation, hemorrhoids, not enough lubrication used during digital stimulation, gas, and bloating. Skin-related issues are also a common cause of autonomic dysreflexia. If you’re unsure what is causing your autonomic dysreflexia, do a thorough skin check to make sure everything looks good. Look for issues such as pressure sores, burns, constrictive clothing, and uncomfortable toes in shoes. Even an uncomfortable placement of the genitalia in your underwear can cause skin-related autonomic dysreflexia.

Here’s a list of the other common causes of autonomic dysreflexia:

– Sexual activity: An orgasm or not using enough lubrication can cause autonomic dysreflexia

– Menstrual cramps

– Labor and delivery

– Heterotopic ossification

– Skeletal fractures

– Appendicitis

– Skin infections

– Cuts and bruises

– Ovarian cysts

– Various abdominal conditions such as gastric ulcers or colitis

If AD persists and the cause cannot be found, go to the ER right away and request a CT scan of the entire body. A full-body CT scan can reveal the cause.

How to Treat AD

If you are experiencing autonomic dysreflexia, make sure you sit upright. This will help lower your blood pressure and alleviate symptoms quickly. Also, remove the cause of the autonomic dysreflexia ASAP (empty your bladder/bowels, etc.) in order to stop your rise in blood pressure. Once the cause of autonomic dysreflexia is removed, your blood pressure will return to its normal metabolic range and, with that, the danger of headache and a stroke will subside.

If you are unable to stop the cause of AD, you can take certain medications that can help bring your blood pressure under control. For immediate relief, take the following medications: Procardia/sublingual, Nitroglycerine sublingual or topically, Clonidine, or Hydralazine. If you experience chronic autonomic dysreflexia, you can take Prazosin or Clonidine daily.

Prevention of AD

Try to be as healthy as possible to avoid autonomic dysreflexia. This means maintaining a regular bowel program, eating a balanced diet, and making sure you are drinking enough water. When you are getting dressed, make sure to look closely at your skin. Have proper seating as well to prevent skin-related issues. It can also be helpful to irrigate your bladder with saline on a regular basis to remove sediment, which can cause irritation and AD.

It is also important to note that many medical professionals, including doctors, do not know about autonomic dysreflexia. If you have to go to the ER, you may need to educate the staff on your condition. Because of this, it is highly important that you keep a autonomic dysreflexia card in your wallet, which you can download for free here: https://www.christopherreeve.org/living-with-paralysis/free-resources-and-downloads/wallet-cards

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Spinal Cord Injury
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