Autonomic Dysreflexia

Autonomic Dysreflexia (AD) is a life-threatening condition that can occur in persons with spinal cord injury. AD is an acute episode of exaggerated sympathetic reflex response. It occurs because SCI disrupts inhibitory feedback mechanisms to the cord below the injury. Without inhibitory feedback, afferent (sensory) stimuli travel uninhibited between reflex centers. It is often brought on by visceral stimuli that normally cause pain or discomfort in the abdominal or pelvic region. It is uncommon for AD to occur until spinal shock has resolved, usually about 6 months after injury. It is most unpredictable during the first year following injury, but can occur throughout the person's lifetime.

AD is usually characterized by hypertension ranging from mild (20 mm hg above baseline) to severe hypertension as high as 300/160, bradycardia and headache ranging from dull to severe and pounding.


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AD most often occurs within the first 6 months after injury.
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AD is associated with injuries at T6 and above. An injury below T6, usually allows sufficient cerebral vasomotor inhibition to control sympathetic reflexes. The inverse is true for injuries at or above T6, uninhibited sympathetic release of norepinephrine and dopamine below the level of injury causes vasospasm, hypertension, skin pallor and gooseflesh associated with the piloerector response. At the same time, baroreceptor function and parasympathetic control of heart rate remain intact. Hypertension produces a baroreflex-mediated vagal slowing of heart rate to bradycardic levels. Accompanying that is a baroreflex-mediated vasodilatation, causing the flushed skin and profuse sweating above the level of injury, along with sudden onset of a pounding headache, nasal stuffiness and feelings of anxiety.

The stimuli for AD to occur can be:

AD is a clinical emergency and can occur very quickly. Without prompt and adequate treatment convulsions, loss of consciousness, intracerebral hemorrhage and death can occur. The most basic treatment includes monitoring the blood pressure, while removing or correcting the initiating cause.

SCI patients and their families should be thoroughly prepared to recognize the possible onset of an episode of AD, and trained to intervene. It is also recommended that both providers and patients take advantage of any opportunities to educate their community about AD, and look to their state's SCI resource center for further information.


We'd like to offer 2 excellent resources about AD.


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One of the first interventions for an episode of AD is to place the patient upright.
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