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Autonomic Dysreflexia

People with spinal cord injures at or above T6 may be at risk for a condition called autonomic dysreflexia that can result in a dangerous spike in blood pressure. In this installment of the Living With a Spinal Cord Injury series, we explain more about the condition and offer advice on recognizing and responding to this condition. 

The Living With a Spinal Cord Injury series is made possible by a gift from David and Barbara Loeb.  

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Read the Transcript

Greenberg: Autonomic dysreflexia, or AD, it is a potentially life-threatening condition. Normally, if something happens to your body, something bad happens, you have the ability to feel it and kind of move away and change the situation. When you've had a spinal cord injury there's problems with both feeling that there is that what we call a noxious or a painful stimulus is there and then sometimes the moving - being able to do something about that stimulus. So what happens is your body likes to send a warning signal just that your brain knows that something bad is going on. It increases your blood pressure. High blood pressure is not good for the body. It puts a lot of stress on the heart so what the body will do is it'll lower the heart rate to try to even things out. And this doesn't really fix the problem because your blood pressure still goes higher and higher and higher until the stimulus is taken away. Uncontrolled high blood pressure can lead to strokes, organ damage, seizures and even death. So it's really important that you figure out what the problem is and fix it.

Narrator: If you have a spinal cord injury at or above T6 you are at risk for developing autonomic dysreflexia, or AD, and you need to fully understand AD symptoms and potential causes. After a spinal injury there are changes in your nervous system that cause your blood pressure to be lower than someone without an injury. Take note of your normal resting blood pressure. For people with an injury at or above T6, the systolic pressure – the top number - is between 90 and 110. If that pressure rises 20 millimeters or more above your normal pressure you might be experiencing AD. Typically you will have other symptoms such as a pounding headache, reddened face, red blotches on the skin, sweating above your level of injury, slow heart rate, goosebumps and anxiety. You can have one or several of these symptoms. Every patient responds differently so it's important to identify if you were at risk.

Stephen: Dysreflexia is a major problem for me and people with spinal cord lesions at the level that I have. It's particularly set off if your bladder becomes over distended and unfortunately I think I have one of the smaller bladder capacities. So when my bladder has about 200 cc's of fluid my nervous system becomes overactive and I get very anxious, a fearful feeling. I start to perspire and feel very hot. It's an extremely uncomfortable feeling and at that point I need to be a catheterized immediately.

Jennifer: Dysreflexia feels like your whole body gets really, really cold and you get goose bumps and you start getting like a cold sweat and your head stars banging. It's like a steady bang. There are stars in your head and very rapidly turns into the worst headache that you could possibly ever have in your life. It literally feels like somebody is hammering your head in.

Narrator: If you have symptoms of autonomic dysreflexia, it's critical that you try to identify the cause quickly. You want to do several simple things to try to bring your blood pressure down at the same time you are determining the cause. Loosen all of your clothing. Take any abdominal binder or TED stockings off. Sit upright in your chair or bed. Don't lie down. When you lay down your blood pressure has a tendency to go even higher. Use prescribed medication as directed. Determine what is bothering your body.

Goodman: Usually the bladder is the most common cause of autonomic dysreflexia. If you have a Foley catheter you want to make sure that the catheter is not kinked at the time. Make sure it's free flowing into the bag. If you're straight cath, you want to catheterize yourself at that moment to make sure that your bladder is not full. If all of those things are fine, then you want to check your bowel to make sure that you are not impacted, there's no stool in the rectal vault. If you have a pressure injury, it could be the pressure injury. It's something that's irritating or painful, so it could be even an ingrown toenail or tight clothing or shoes that are rubbing on you. It's something that you can't sense but your body feels that pain. You could have a urinary tract infection also. Anything can trigger the autonomic dysreflexia condition.

Greenberg: If your blood pressure, which is normally that top number is a hundred, you know you haven't cathed yourself when you're supposed to, you do cath yourself, you empty your bladder and that blood pressure hasn't really come down very much or hasn't changed at all within 30 minutes, you need to seek emergency medical help. Remember high blood pressure leads to really bad things so that if it hasn't - even if it's resolving but hasn't resolved a lot - it's still a good idea to go seek medical help.

Narrator: There are several simple prevention techniques that will help to reduce your AD risk. Be compliant with your bladder management, routine with your bowel program, maintain an active lifestyle that keeps your skin healthy and know the risks you have for AD and the steps to take to eliminate the problem.

Jennifer: When it starts happening, I have my mom check my blood pressure and after that happens I have a gel that you just put like on a slip of paper and you put it on your arm and it slowly starts dilating. The dysreflexia start slowly like going down and down. Then after that you retake your blood pressure until it starts going away.

Greenberg: Whatever the problem is you need to be good about managing it. If it's bladder, you have to do your bladder program. We have patients sometimes who think. " Oh if I'm supposed to cath six times a day, well, is it really that big a deal if I miss one or two. It is. Same thing with bowel. You have to be good about doing your bowel routine. You have to be good about doing skin checks, making sure that you're not getting pressure injuries. Dysreflexia might be the first sign that there is a problem with your skin. 

Narrator: Being connected with your rehabilitation doctor and the rehab team will provide you with the best education and recommendations to assure you stay healthy and can manage common complications you might experience as someone living with an SCI.

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