Autonomic dysreflexia occurs 1 month to 1 year later in 20% to 70% of people who have had a spinal cord injury.
The autonomic nervous system is the part of the nervous system that regulates body processes, such as blood pressure, urination, bowel movements, digestion, erection, breathing, vision, sweating, and salivation. When the spinal cord is injured, certain nerves in the autonomic nervous system may overreact to the injury or to some other problem, causing blood vessels to narrow and blood pressure to increase. Normally, other autonomic nerves send signals down the spinal cord to widen blood vessels, allowing the blood vessels to carry more blood and thus lower blood pressure. However, when the spinal cord is injured, nerve signals cannot always travel down the spinal cord to widen blood vessels, and blood pressure may remain high.
Autonomic dysreflexia may be triggered by
A urinary tract disorder, such as a distended bladder or urinary tract infection Overview of Urinary Tract Infections (UTIs) In healthy people, urine in the bladder is sterile—no bacteria or other infectious organisms are present. The tube that carries urine from the bladder out of the body (urethra) contains no bacteria... read more
A distended intestine
Some surgical procedures
Sometimes sexual intercourse
The bladder may become distended when people cannot empty their bladder (urinary retention Urinary Retention Urinary retention is inability to urinate or incomplete emptying of the bladder. People who have incomplete emptying of the bladder may have urinary frequency or urinary incontinence. If the... read more ) or when a flexible tube used to drain urine (urinary catheter) is blocked. The intestine may be distended when people are constipated Constipation in Adults Constipation is difficult or infrequent bowel movements, hard stool, or a feeling that the rectum is not totally empty after a bowel movement (incomplete evacuation). (See also Constipation... read more or have a blockage in the intestine Intestinal Obstruction An obstruction of the intestine is a blockage that completely stops or seriously impairs the passage of food, fluid, digestive secretions, and gas through the intestines. The most common causes... read more .
Symptoms of Autonomic Dysreflexia
Symptoms of autonomic dysreflexia vary. They usually begin suddenly and occur intermittently.
People with this disorder may have headaches. They may feel nauseated and vomit. They may sweat profusely and be flushed. The skin may be dry and pale. Other symptoms include problems with vision, nasal congestion, and feelings of anxiety and doom.
High blood pressure may suddenly increase even more (called hypertensive emergency Classification of blood pressure ). Hypertensive emergency is life-threatening. People with hypertensive emergency may have a severe, throbbing headache, blurred vision, confusion, chest pain, shortness of breath, and seizures.
Diagnosis of Autonomic Dysreflexia
A doctor's evaluation
Doctors suspect autonomic dysreflexia when people have a spinal cord injury in the upper back and very high blood pressure, especially if they also have a distended bladder or intestine.
They also check for possible triggers of autonomic dysreflexia, such as a distended bladder.
Treatment of Autonomic Dysreflexia
Correction of the cause
Control of blood pressure
Doctors remove or correct the problem causing autonomic dysreflexia.
Very high blood pressure is immediately treated with medications that work quickly, such as nitroglycerin, hydralazine, labetalol, or nifedipine.
Doctors may refer pregnant women to an obstetrician who specializes in treating disorders such as autonomic dysreflexia.
OnabotulinumtoxinA (a medication used to block nerve activity), injected into the main bladder muscle, may help prevent episodes of autonomic dysreflexia.