- autonomic dysreflexia
Autonomic hyperreflexia is an abnormal triggering of the autonomic nervous system. It occurs after a spinal cord injury. The body is unable to turn off the nerves that cause blood pressure to rise.
What is going on in the body?
Normally, the autonomic nervous system controls blood pressure automatically. It does this by commanding muscles around blood vessels to tighten or relax in order to raise or lower blood pressure. The nervous system can monitor blood pressure and continually adjusts the commands to keep blood pressure normal.
When a person has a spinal cord injury, the damage to the nerve pathways in the spinal cord can result in the loss of their ability to control the responses of the blood vessels. If the damage is at or above the middle of the back (the level called T6 for the sixth of the twelve thoracic vertebrae), the person may develop autonomic hyperreflexia. Damage to the spinal cord at lower levels will not cause this condition.
In autonomic hyperreflexia, the autonomic nervous system can still cause the blood pressure to rise. But it cannot easily cause it to come back down.
What are the causes and risks of the disease?
Below the level of damage in the spinal cord, the person usually is paralyzed and cannot feel normal sensations. Autonomic hyperreflexia occurs when an irritating stimulus occurs that the person cannot feel.
The most common cause is a very full bladder. The bladder sends signals through the nervous system to the brain. The signals cannot get through because of the spinal cord damage. The person cannot feel that the bladder is full and needs to be emptied. But the automatic part of the nervous system that controls the blood pressure is triggered nonetheless and causes the blood pressure to go up.
Other common causes are a full bowel, an infection, or a sore on the skin. Women with spinal cord injuries who have menstrual cramps may also have autonomic hyperreflexia. Sometimes the trigger is as simple as accidentally sitting on a hard object or having clothing bunched up.
What can be done to prevent the disease?
A person with a spinal cord injury needs to learn the symptoms and causes of autonomic hyperreflexia. Keeping the bladder and bowel empty, taking good care of the skin, and avoiding infections are also key actions that can help. A person with spinal cord injury should be educated about this condition as part of his or her rehabilitation process.
How is the disease diagnosed?
Usually the person begins to feel the symptoms and quickly recognizes the autonomic hyperreflexia. Checking the blood pressure can confirm the hyperreflexia. It is important to begin right away to look for the cause and fix it.
Long Term Effects
What are the long-term effects of the disease?
Once the cause of the autonomic hyperreflexia is removed, the condition goes away quickly. There are no long-term effects if the hyperreflexia is treated promptly. If treatment is not quick enough or is inadequate, the person may have a stroke. The stroke may cause speech impairments, cognitive impairments, and mobility impairments.
What are the risks to others?
There are no risks to others.
What are the treatments for the disease?
Autonomic hyperreflexia is a medical emergency. If the blood pressure stays high or continues to go up, a stroke can occur. Fortunately, the condition is easy to treat by removing whatever is causing the autonomic hyperreflexia. This means emptying the bladder or bowels and making sure the person is not sitting on bunched-up clothing or a hard object.
If the person is lying down, sitting up can help lower the blood pressure. Once the cause is removed, the symptoms improve quickly. If the cause cannot be found or the problem persists, the person or caregiver will need to contact emergency medical services right away. Medicines can be used to bring the blood pressure down to normal.
What are the side effects of the treatments?
Side effects vary depending on the medicines used to lower the blood pressure but may include allergic reactions.
What happens after treatment for the disease?
Autonomic hyperreflexia goes away quickly once the cause is removed. Because the problem can return, care must always be taken to prevent another episode.
How is the disease monitored?
Usually, the person will notice symptoms as they occur. Thus, he or she can make sure the problem is quickly taken care of. When an episode occurs unexpectedly, the person should notify the healthcare provider. Any new or worsening symptoms should be reported as well.
Acute management of autonomic dysreflexia: adults with spinal cord injury presenting to health-care facilities, Paralyzed Veterans of America, Consortium for Spinal Cord Injury, 1997
Rehabilitation/restorative care in the community, Hoeman, 1990