Summary about Disease
Autonomic Dysreflexia (AD) is a syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries at or above the sixth thoracic vertebra (T6) level, although it can occur with injuries below T6. AD is triggered by noxious (painful or irritating) stimuli below the level of the injury. Because the spinal cord injury blocks communication between the brain and the body, the autonomic nervous system reacts uncontrollably, leading to a dangerous rise in blood pressure. This can lead to serious complications if left untreated.
Symptoms
Symptoms of Autonomic Dysreflexia can vary but often include:
Sudden, severe headache
Elevated blood pressure (often very high, such as 200/100 mmHg or higher)
Profuse sweating above the level of the spinal cord injury (e.g., face, head, neck)
Flushing of the skin above the level of the injury
Goosebumps below the level of the injury
Slow heart rate (bradycardia)
Blurred vision or spots in the visual field
Nasal congestion
Anxiety
Feeling of apprehension
Causes
AD is caused by noxious stimuli below the level of the spinal cord injury that the body cannot process normally due to the spinal cord damage. Common triggers include:
Bowel issues: Constipation, fecal impaction, bowel distention.
Bladder issues: Bladder distention (full bladder), urinary tract infection, blocked catheter, bladder spasms.
Skin issues: Pressure sores, ingrown toenails, burns, tight clothing.
Pain: Any painful stimuli below the level of injury.
Other: Sexual activity, labor and delivery, surgery, certain medical procedures.
Medicine Used
Medications are used to lower blood pressure quickly during an episode of AD. Some commonly used medications include:
Nifedipine: A calcium channel blocker, often administered sublingually (under the tongue) for rapid absorption.
Nitroglycerin: A vasodilator that can be administered sublingually or topically.
Hydralazine: A vasodilator administered intravenously (IV) if other measures are not effective.
Captopril: An ACE inhibitor. For prevention, management focuses on preventing the triggers.
Is Communicable
Autonomic Dysreflexia is not a communicable disease. It is a syndrome that arises from a spinal cord injury or certain other neurological conditions. It is not caused by an infectious agent and cannot be transmitted from person to person.
Precautions
Prevention is key. Precautions include:
Regular bowel care: Maintain a regular bowel program to prevent constipation and impaction.
Proper bladder management: Ensure proper catheterization techniques, regular bladder emptying, and monitor for urinary tract infections.
Skin care: Regular skin checks to prevent pressure sores and prompt treatment of any skin issues. Avoid tight clothing.
Education: Educate individuals with spinal cord injuries, their caregivers, and healthcare providers about AD, its triggers, symptoms, and emergency management.
Emergency plan: Develop a written emergency plan with clear steps for managing AD episodes, including contact information for healthcare providers and emergency services. Carry information about the condition in case of emergencies.
How long does an outbreak last?
An episode of Autonomic Dysreflexia can last from a few minutes to several hours if the triggering stimulus is not identified and removed. The faster the trigger is addressed, the shorter the episode. Untreated episodes can lead to serious complications.
How is it diagnosed?
Diagnosis is primarily based on clinical presentation:
Medical History: A history of spinal cord injury at or above T6.
Physical Examination: Elevated blood pressure (typically significantly higher than baseline) along with other characteristic symptoms.
Trigger Identification: Attempting to identify the noxious stimulus triggering the response.
Resolution with Trigger Removal: Blood pressure returning to normal after the trigger is removed is highly suggestive of AD.
Blood pressure monitoring: Continuous monitoring is essential during an episode.
Timeline of Symptoms
The timeline of symptoms in AD is typically rapid. 1. Triggering Event: A noxious stimulus occurs (e.g., bladder distension). 2. Rapid Increase in Blood Pressure: Within seconds to minutes, blood pressure rises dramatically. 3. Other Symptoms Appear: Headache, sweating, flushing, goosebumps, bradycardia, and other symptoms develop concurrently with the elevated blood pressure. 4. Resolution (with intervention): Once the trigger is removed or treated, symptoms begin to subside relatively quickly, and blood pressure returns to baseline. 5. Prolonged Symptoms (without intervention): If the trigger is not removed, the episode can persist for hours, and complications can occur.
Important Considerations
AD is a medical emergency that requires prompt recognition and treatment.
Individuals with spinal cord injuries and their caregivers should be educated about AD and how to manage it.
Healthcare providers should be aware of the condition and its management.
Prompt identification and removal of the triggering stimulus are crucial to resolving the episode.
If the trigger cannot be quickly identified or removed, medications to lower blood pressure should be administered.
Prevention is key to managing AD; this involves careful attention to bowel and bladder management, skin care, and avoiding other potential triggers.
Long-term, poorly controlled AD can lead to serious complications such as stroke, seizures, and death.