dysreflexia

Autonomic dysreflexia, commonly called dysreflexia, is a medical emergency affecting people with spinal cord injuries at or above the T6 level. It involves a sudden, life-threatening rise in blood pressure in response to stimuli below the level of injury. Early recognition and treatment are essential to prevent complications such as stroke, seizure, or organ damage.

The condition arises because supraspinal control of autonomic reflexes is disrupted by the spinal cord injury. Noxious stimuli below the injury—such as a full bladder, urinary retention, bowel impaction, skin irritation, pressure sores, or tight clothing—trigger a sympathetic surge that causes vasoconstriction below the injury. The resulting hypertension triggers reflex changes above the injury, including sweating and flushing.

Common signs and symptoms include a sudden severe hypertension (often with headache), sweating or flushing above the injury level, pallor or cold skin below the level of injury, nasal congestion, blurred vision, anxiety, and a feeling of impending doom. It most often occurs in injuries above T6 and can recur if triggers are not addressed.

Diagnosis is clinical, based on sudden hypertension in a person with a spinal cord injury. Immediate management steps: sit the patient upright to lower blood pressure, remove tight clothing and devices, and identify and relieve triggers (emptying the bladder with catheterization, checking for blockage, emptying the bowels, removing constrictive items). After the trigger is removed, monitor BP closely. If blood pressure remains elevated, administer rapid-acting antihypertensives (for example, sublingual nifedipine 10 mg or nitroglycerin 0.4 mg) per local protocols, and seek urgent medical care if there is no improvement within minutes.

Prevention focuses on ongoing bladder and bowel management, routine monitoring, prompt treatment of infections, and education of patients and caregivers to recognize early symptoms. With prompt treatment, most episodes resolve without lasting harm, but delayed treatment can lead to serious complications.