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Autonomic Dysreflexia

Chirag N. Shah, MD, Michael DiGaetano, M.D. and Grant Wei, FACEP, MD Reviewed 04/2024
 


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

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

HISTORY

  • Minimal or no symptoms despite an elevated BP (silent AD i...

TREATMENT

  • Patient should be sat upright: Orthostasis reduces BP (2)[A].

  • Most important step is removing the causative stimulus  (2)[A],(3)[A]. Specific recommendations:

    • Pressure relief; loosening const...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

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

  • For recurrent AD, consider the α1-blockers prazosin or terazosin as above.

Patient Monitoring

REFERENCES

1
Liu  N, Zhou  M, Biering-Sørensen  F, et al. Iatrogenic urological triggers of autonomic dysreflexia: a systematic review. Spinal Cord.  ...

ADDITIONAL READING

  • Fauss GNK, Hudson KE, Grau JW. Role of Descending Serotonergic Fibers in the Development of Pathophysiology after Spinal Cord Injury (SCI): Contribution to Chronic Pain, ...

CODES

ICD10

G90.4 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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