Dysreflexia, more accurately known as autonomic dysreflexia (AD), is an abnormal, overreaction of the involuntary (autonomic) nervous system to stimulation below the level of a spinal cord injury. This condition is a medical emergency and requires immediate attention.
Understanding Autonomic Dysreflexia
Autonomic dysreflexia primarily affects individuals with spinal cord injuries at or above the T6 level (sixth thoracic vertebra). The severity of the condition can vary, but it is crucial to recognize and manage it promptly to prevent serious complications like stroke, seizure, or even death.
What Triggers Autonomic Dysreflexia?
The trigger for autonomic dysreflexia is typically a stimulus below the level of the spinal cord injury that the brain cannot process normally. Common triggers include:
- Bowel Issues: Constipation, fecal impaction, or bowel distension.
- Bladder Issues: A full bladder, urinary tract infection, blocked catheter, or bladder spasms.
- Skin Irritation: Pressure sores, tight clothing, burns, or ingrown toenails.
- Painful Stimuli: Fractures, surgical procedures, or other sources of pain below the level of injury.
- Other Stimuli: Sexual activity, labor and delivery, or even temperature changes.
Signs and Symptoms of Autonomic Dysreflexia
Symptoms of autonomic dysreflexia can appear suddenly and can rapidly escalate. Key signs and symptoms include:
- Severe High Blood Pressure: Significantly elevated blood pressure, often dangerously high.
- Pounding Headache: Often described as severe and throbbing.
- Profuse Sweating: Especially above the level of injury.
- Flushing of the Skin: Redness above the level of injury.
- Slow Heart Rate (Bradycardia): Although a fast heart rate is also possible.
- Goosebumps: Occurring below the level of injury.
- Blurred Vision or Spots in Vision.
- Nasal Congestion.
- Anxiety or Apprehension.
Management of Autonomic Dysreflexia
The immediate steps to manage autonomic dysreflexia involve:
- Sit the Person Up: Immediately raise the individual to a sitting position with legs dangling to help lower blood pressure.
- Loosen Tight Clothing: Remove any constrictive clothing or devices.
- Check Blood Pressure: Monitor blood pressure every 2-5 minutes.
- Identify and Remove the Trigger: Systematically check for common triggers like a full bladder (check catheter for kinks or blockages), bowel impaction, or skin irritation.
- Seek Medical Attention: If blood pressure remains high after addressing potential triggers, seek immediate medical attention. Medication may be required to lower blood pressure.
Prevention of Autonomic Dysreflexia
Preventive measures are essential for individuals at risk of autonomic dysreflexia:
- Regular Bowel Program: Maintain a consistent bowel management routine to prevent constipation.
- Proper Bladder Management: Ensure proper catheter care and regular bladder emptying.
- Skin Care: Inspect skin regularly for pressure sores or irritation.
- Education: Educate the individual, their family, and caregivers about the signs, symptoms, and management of autonomic dysreflexia.
Autonomic dysreflexia is a serious condition that requires prompt recognition and management. Understanding the triggers, symptoms, and immediate steps for intervention are crucial for preventing potentially life-threatening complications.
