Autonomic dysreflexia in the Spinal Cord Inured

The life of the spinal cord injured (SCI) individual is filled with complications. Living with SCI is not easy and as patient once told me “spinal cord injury is not for sissies!” Never has a truer word ever been spoken. One of the complications often not very well explained to patients is that of autonomic hyperreflexia (also known as AD, dysreflexia or just hyperreflexia).

Autonomic hyperreflexia is a medical emergency and so the SCI need to know more about this condition. It is only found in individuals who sustain an injury from the T6 level or above. It is important to understand the symptoms because if you suffer from this, then you need to know what symptoms to look out for. As mentioned an acute dysreflexic attack is an emergency – ignoring the symptoms or not treating the cause can be fatal, or result in a large bleed on the brain resulting in an even greater degree of disability. Hyperreflexia is a condition peculiar to SCI persons. Most medical practitioners and nurses might not have ever heard of it, so it’s important that you understand it. The condition occurs in some SCI individuals due to the imbalance between sympathetic and parasympathetic nerve function – in high injuries the sympathetic nerve pathways may be damaged.

The symptoms

If you have a spinal injury at, or above T6 you could suffer from this condition. The symptoms are one or all of the following:

  • SEVERE pounding headache.
  • Gooseflesh and sweating above the level of injury.
  • Pilo-erection – the hairs on the arms standing up (like when you are cold).

The clinical signs:

  • Slow pulse.
  • Patchy red marks on the face and neck.
  • Very high blood pressure.

Hyperreflexia does not occur before six weeks after acute injury and usually runs its course after three to four years - but might be persistent. The complex of symptoms is triggered commonly by distension of the bladder or bowel and reversing the symptoms then means reversing, or treating the cause. As the main problem is a dangerously elevated blood pressure, the following should be done immediately if an attack occurs:

  1. Reverse the cause – this usually means changing the catheter if blocked or attending to an over distended bowel. However, other causes that may not be easily reversed are pressure sores, acute injury as with long bone fractures, UTI, etc. In fact dysreflexia can be triggered by just about anything including sexual intercourse!
  2. Sit up – this will lower the blood pressure.
  3. If required take appropriate medication to lower the blood-pressure. If you do have severe AD then your doctor will have prescribed Adalat which can be taken in an emergency.

Recognising the symptoms is VERY important. Some SCI individuals have such bad AD that even inserting a suppository or passing a stool triggers an attack. If this occurs speak to your doctor about taking prophylactic medication, or discussing alternatives.