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Autonomic dysreflexia

Autonomic hyperreflexia; Spinal cord injury - autonomic dysreflexia; SCI - autonomic dysreflexia

Autonomic dysreflexia is an abnormal, overreaction of the involuntary (autonomic) nervous system to stimulation. This reaction may include:

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Central nervous system and peripheral nervous system

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Causes

The most common cause of autonomic dysreflexia (AD) is spinal cord injury. The nervous system of people with AD over-responds to the types of stimulation that do not bother healthy people.

Other causes include:

Symptoms

Symptoms can include any of the following:

Sometimes there are no symptoms, even with a dangerous rise in blood pressure.

Exams and Tests

The health care provider will do a complete nervous system and medical examination. Tell the provider about all the medicines you are taking now and that you took in the past. This helps determine which tests you need.

Tests may include:

Other conditions share many symptoms with AD, but have a different cause. So the exam and testing help the provider rule out these other conditions, including:

Treatment

AD is life threatening, so it is important to quickly find and treat the problem.

A person with symptoms of AD should:

Proper treatment depends on the cause. If medicines or illegal drugs are causing the symptoms, those drugs must be stopped. Any illness needs to be treated. For example, the provider will check for a blocked urinary catheter and signs of constipation.

If a slowing of the heart rate is causing AD, drugs called anticholinergics (such as atropine) may be used.

Very high blood pressure needs to be treated quickly but carefully, because the blood pressure can drop suddenly.

A pacemaker may be needed for an unstable heart rhythm.

Outlook (Prognosis)

Outlook depends on the cause.

People with AD due to a medicine usually recover when that medicine is stopped. When AD is caused by other factors, recovery depends on how well the disease can be treated.

Possible Complications

Complications may occur due to side effects of medicines used to treat the condition. Long-term, severe high blood pressure may cause seizures, bleeding in the eyes, stroke, or death.

When to Contact a Medical Professional

Call your provider right away if you have symptoms of AD.

Prevention

To prevent AD, do not take medicines that cause this condition or make it worse.

In people with spinal cord injury, the following may also help prevent AD:

References

Cheshire WP. Autonomic disorders and their management. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 390.

Cowan H. Autonomic dysreflexia in spinal cord injury. Nurs Times. 2015;111(44):22-24. PMID: 26665385 pubmed.ncbi.nlm.nih.gov/26665385/.

McDonagh DL, Barden CB. Autonomic dysreflexia. In: Fleisher LA, Rosenbaum SH, eds. Complications in Anesthesia. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 131.

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Review Date: 6/23/2020  

Reviewed By: Amit M. Shelat, DO, FACP, FAAN, Attending Neurologist and Assistant Professor of Clinical Neurology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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