Autonomic Dysreflexia: Causes, Symptoms, Treatment, Complications, Prevention

Autonomic Dysreflexia also known as autonomic hyperreflexia is a rare and life-threatening medical condition, which mostly occurs due to injuries in the upper back or the spinal cord. In this condition, the patient’s blood pressure shoots up rapidly and the heart rate drops down and becomes irregular, leading to cardiac arrests, strokes, and seizures.

In Autonomic Dysreflexia, the involuntary nervous system tends to overreact to external-stimulus and body- stimulus. People suffering from problems like multiple sclerosis, Guillain-Barre syndrome or any kind of head and brain injury are also prone to Autonomic Dysreflexia. It could also be the side effect due to the consumption of certain medications.

In patients with spinal injuries, the communication between the parasympathetic nervous system and the sympathetic nervous system gets hindered. Since their roles are complementary to each other, the stimulation of one will not correspond to the suppression of other leading to problems like these.

The symptoms of autonomic dysreflexia include:

• A severe headache
• Red blotches on the skin
• Stuffy nose
• Nausea
• Excessive sweating etc.
• Blurred vision.

Autonomic dysreflexia occurs in people who have a spinal injury, have undergone a surgery or have a tumor occurring at the T6 level or above. However, in some cases, autonomic dysreflexia has also occurred in cases of lower back injuries. In patients with spinal pathology, the various stimuli have been known to cause autonomic dysreflexia. Some of these are listed below:

• Excessively filled the bladder, with the inability to pass urine
• Urinary tract infection (UTI)
• Obstructed catheter in the bladder
• Constipation or excessively filled bowel
• Gallbladder stone, stomach ulcers or gastritis
• Tight outfits
• Broken bones or injuries
• Sexual activities
• Ingrown nails.

People with spinal injuries must seek medical help at the earliest. Doctors will conduct various tests to get to the root of the problem as such and rectify it in the early stage itself.

Tests to diagnose Autonomic dysreflexia may include:

• Echocardiogram (ECG) to check the heart-functions
• Blood and urine tests
• Magnetic resonance imaging (MRI) or X-Ray of the spine
• Ultrasound to check the presence of gallstones.

Rapidly acting vasodilators, sublingual nitrates, tropical nitrates, oral hydralazine, and clonidine are some of the drugs used in the treatment of autonomic dysreflexia. Ganglionic blockers are incorporated to control sympathetic nervous system outflow. Topical nitroglycerin ointment can be used to apply on the forehead or chest wall, this will help to bring the blood pressure to a normal rate. Administration of anti-hypertensive can be used to eliminate triggering stimuli.

When the problem is triggered, it requires immediate medical attention otherwise it might lead to strokes and cardiac arrest. Patients are advised to sit up straight or raise their heads to 90 degrees and lower their legs. If they are wearing body-hugging clothes, it must be either loosened or removed. It is important to keep a check on the blood pressure in every few minutes. The bladder and the bowel must be emptied, using a catheter and digital stimulation respectively.

In some patients, autonomic dysreflexia will first occur after weeks of the spinal injury, whereas in others it can even occur after years of the injury. The delay in the diagnosis will lead to a worsening of the situation. Gradually it might become chronic and recurrent.

For people with spinal cord injuries, the following measures will prove to be helpful in preventing autonomic dysreflexia:

• Make sure the bladder is empty.
• If there is a catheter, make sure it is draining urine.
• In case of constipation, treat it at the earliest.
• Make sure that there are no Urinary tract infections (UTI).
• Make sure the skin is free from allergies, sores, and infections
• A proper and prompt management of the condition will help in preventing autonomic dysreflexia from worsening.