Uncontrolled reflex responses: Explanation, signs, and further details
Autonomic Dysreflexia (AD) is a potentially life-threatening condition that commonly affects individuals with spinal cord injuries (SCI) at or above the T6 level. This condition disrupts the body's automatic functions, such as heartbeat, blood pressure regulation, breathing, and digestion.
The autonomic nervous system, which regulates these functions, consists of two parts: the sympathetic nervous system, responsible for speeding up the body's reactions, and the parasympathetic nervous system, responsible for slowing down the body's reactions. When a noxious stimulus, such as a bladder distension or a skin irritation, occurs below the injury level, it can trigger an uncontrolled sympathetic nervous system response, leading to a dangerous rise in blood pressure.
Common triggers for AD in individuals with SCI above the T6 level include bladder-related issues, bowel-related issues, skin irritations, tight or restrictive clothing, muscle spasms, and sexual activity. Bladder-related issues may include urinary retention or a blocked urinary catheter, urinary tract infections, or high bladder pressure caused by detrusor sphincter dyssynergia (DSD) or uninhibited bladder contractions. Bowel-related issues might involve constipation or fecal impaction, rectal stimulation, or bowel programs. Skin irritations can stem from pressure ulcers or wounds, skin irritation from tight clothing, restrictive devices like abdominal binders, compression socks, belts, or resting hand splints, or improper positioning causing pressure or trauma.
If AD is suspected, it is crucial to identify and remove the trigger promptly. This may involve emptying a distended bladder, relieving bowel impaction, removing tight clothing, or addressing skin irritations.
Symptoms of AD can range from mild to severe and include headache, tachycardia (rapid heart rate), bradycardia (slow heart rate), hypertension (high blood pressure), anxiety, changes in vision, goosebumps, nasal congestion, sweating, flushed skin, tingling sensation, chills without fever, nausea, cold, clammy skin, paleness, and more.
High blood pressure associated with AD can lead to serious complications such as a cerebral bleed, stroke, myocardial infarction (heart attack), pulmonary edema (fluid in the lungs), and kidney failure. If a person cannot identify a trigger or if high blood pressure does not reduce, they should call 911 or seek emergency medical services immediately.
Doctors can often diagnose AD with a combination of blood pressure increases, knowledge of a spinal cord injury, and any presenting symptoms. It is essential for people with SCI at or above the T6 level to learn the symptoms of AD to quickly detect any possible symptoms and take prompt action to prevent serious complications.
[1] Mayo Clinic. (2021). Autonomic dysreflexia. https://www.mayoclinic.org/diseases-conditions/spinal-cord-injury/in-depth/autonomic-dysreflexia/art-20045573
[2] National Spinal Cord Injury Association. (n.d.). Autonomic Dysreflexia. https://www.spinalcord.org/live-with-sci/health/autonomic-dysreflexia
[3] American Spinal Cord Injury Association. (n.d.). Autonomic Dysreflexia. https://www.ascia.org/Resources/Living-with-SCI/Autonomic-Dysreflexia
- Individuals with spinal muscular atrophy, a type of neurological disorder, might also be at risk for Autonomic Dysreflexia (AD), given the involvement of the spinal cord.
- Awareness and education about the symptoms of AD, such as headache, hypertension, and tingling sensations, are crucial for caregivers of individuals with spinal cord injuries (SCIs) and other medical conditions related to health and wellness.
- Science and medical advancements have led to various therapies for managing AD, including spinal cord stimulation, which can help regulate the body's autonomic responses and reduce the risk of complications like heart attack and stroke.
- To prevent AD-related emergencies, caregivers should ensure prompt recognition and removal of triggers, such as bladder-related issues, bowel-related issues, skin irritations, tight clothing, or misaligned positions that might cause pressure or trauma.
- With proper care, monitoring, and therapy, individuals with spinal cord injuries (SCIs) can lead a healthier life, managing their conditions, and reducing the impact of complications like AD on their daily lives.
