Managing Autonomic Dysreflexia: Clinical Insights and Strategies

Abstract

Autonomic dysreflexia is a medical emergency that can occur in individuals with spinal cord injuries at or above the T6 level. This condition is characterized by a sudden, dangerous increase in blood pressure due to spinally mediated reflex activation of sympathetic vasoconstrictor neurons in response to various stimuli below the level of injury. If left untreated, autonomic dysreflexia can lead to severe complications such as stroke, seizures, and even death. The condition is typically recognized during the chronic phase of spinal cord injuries but can also occur in the early stages after injury. This chapter provides an in-depth discussion of autonomic dysreflexia, including its clinical features, pathophysiology, and management strategies. The chapter also highlights the importance of recognizing the signs and symptoms of autonomic dysreflexia and initiating prompt treatment to prevent complications. The author reviews the various triggers for autonomic dysreflexia, such as bladder and bowel distention, skin irritation, and pressure injuries, and provides practical recommendations for minimizing these triggers in clinical practice. The chapter also outlines the diagnostic criteria for autonomic dysreflexia, which include a significant increase in systolic blood pressure (>20 mmHg) accompanied by symptoms such as headache, flushing, and sweating. The authors emphasize the importance of continuous blood pressure monitoring and the use of pharmacological interventions such as nifedipine and nitroglycerin to manage acute episodes of autonomic dysreflexia.