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Autonomic Dysreflexia

Chirag N. Shah, MD, FACEP and Richard J. Chen, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

Autonomic dysreflexia (AD) is a medical emergency characterized by a sudden and uncontrolled sympathetic response in patients with spinal cord injury (SCI) at T6 and above. It is sec...

DIAGNOSIS

AD is a clinical diagnosis. Most studies use a 20- to 30-mm Hg increase in the systolic BP in response to a noxious stimulus to define AD in adult patients. 

HISTORY

  • Minimal or no symptoms des...

TREATMENT

  • Patient should be sat upright: Orthostasis reduces BP (1)[A].

  • Most important step is removing the causative stimulus (1)[A]. Specific recommendations:

    • Loosening constrictive clothing or device...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Patient and family education regarding early recognition and prevention of AD

  • For recurrent AD, consider the α1-blockers prazosin (3)[B] or terazosin as above (3)[...

REFERENCES

1
Consortium for Spinal Cord Medicine. Acute Management of Autonomic Dysreflexia: Individuals with Spinal Cord Injury Presenting to Health-Care Facilities. 2nd ed. Washington, DC: Paralyzed ...

ADDITIONAL READING

  • Cormier CM, Mukhida K, Walker G, et al. Development of autonomic dysreflexia after spinal cord injury is associated with a lack of serotonergic axons in the intermediolateral cell c...

CODES

ICD10

G90.4 Autonomic dysreflexia 

ICD9

337.3 Autonomic dysreflexia 

SNOMED

129618003 autonomic dysreflexia (disorder) 

CLINICAL PEARLS

  • AD is a potentially life-threatening but reversible disorder, so early recognition and prevention are vital.

  • Normal BP for a quadriplegic could be 90/60 mm Hg; hence, even 120/80 mm Hg ...

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