Automatic Dysreflexia
NUR 420 Palliative & Geriontology Nursing
Daystar University

DEFINITION
• It is a condition that results from an exaggerated response of the autonomic
nervous system to a noxious stimulus below the level of spinal injury. This
response causes an uncontrolled and rapid increase in blood pressure, which can
lead to serious complications such as stroke, seizures, and cardiac arrest if left
untreated.
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PATHOPHYSIOLOGY
• The pathophysiology of autonomic dysreflexia involves an overreaction of the
sympathetic nervous system, which causes vasoconstriction and a rapid increase in blood
pressure. This increase in blood pressure stimulates the baroreceptors in the carotid
sinus and aortic arch, but the reflex response is blocked by the spinal cord injury, leading
to persistent hypertension. The symptoms of autonomic dysreflexia are caused by the
activation of the sympathetic nervous system.
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CAUSES
• Bladder problems – full distended bladder urinary tract infection. Most common
cause.
• Bowel- hard stool in the rectum causes impaction.
• Breakdown of skin-pressure ulcer, skin infection occurring below the site of injury.
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CLINICAL MANIFESTATION
1. Severe headache
2. Profuse sweating: The body may sweat excessively, even in cool or cold environments.
3. Flushing: The skin may become red and warm to the touch.
4. Piloerection: The hairs on the arms, legs, or back may stand on end.
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5 Nasal congestion: The individual may experience stuffy or runny nose.
6 Nausea: The individual may feel sick to their stomach.
7 Bradycardia: The heart rate may slow down.
8 Rapid increase in blood pressure: This is the most significant and potentially life-threatening
symptom of autonomic dysreflexia. Blood pressure can rise rapidly and cause serious complications,
such as seizures, stroke, or even death.
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DIAGNOSTIC PROCEDURES
• There’s no single test that can diagnose autonomic dysreflexia (AD), so healthcare providers and
caregivers largely base the diagnosis on the:
 Medical history, especially history of a spinal cord injury.
 Current blood pressure compared to your baseline or “usual” blood pressure. Systolic blood pressure
greater than 150 mmHg or more than 40 mmHg above baseline levels is usually considered indicative
of autonomic dysreflexia.
 Symptoms, especially severe headache.
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Cont…
 Blood and urine tests.
 Computed tomography (CT) and Magnetic Resonance Imaging (MRI)
 Electrocardiogram and Spinal puncture
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Cont…
• Tilt-table test- the patient lies on a table that can be tilted up to a
standing position. Blood pressure, heart rate, and other vital signs are
monitored while the table is tilted to different angles. If the patient
experiences symptoms such as headache, sweating, nausea, or a
sudden increase in blood pressure, it may indicate autonomic
dysreflexia.
• X ray
• Drug testing
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MEDICAL MANAGEMENT
- The most common agents used are nifedipine and nitrates.
- Bite and swallow is the preferred method of administering nifedipine and not sublingual
administration.
- Other agents used are prazosin, captopril, terazosin, mecamylamine, diazoxide and
phenoxybenzamine
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Cont…
- Antihypertensives should be used with great caution with patients who have coronary artery disease.
- If there’s poor response to treatment and the cause of automatic dysreflexia has not been identified
the patient should be seen in an emergency department for monitoring and pharmacologic control of
blood pressure.
- There’s evidence that electrical stimulation of the spinal cord maybe a useful therapy though it’s not
clear
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SURGICAL MANAGEMENT
• Sympathectomy: This is a surgical procedure that involves cutting or blocking the sympathetic nerve fibres
that control blood vessel constriction. This can help to reduce blood pressure and alleviate symptoms of AD.
- Sacral nerve stimulation: This involves implanting a device that delivers electrical stimulation to the sacral
nerves, which can help to control bladder and bowel function and reduce the frequency of AD episodes.
- Intrathecal baclofen pump: This involves implanting a device that delivers a muscle relaxant medication
called baclofen directly to the spinal cord, which can help to reduce muscle spasms and prevent AD.
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PALLIATIVE NURSING CARE
• Assessment: The nurse should assess the individual for signs and symptoms of autonomic
dysreflexia, such as severe headache, profuse sweating, flushing, piloerection, nasal congestion,
nausea, bradycardia, and rapid increase in blood pressure. Blood pressure should be assessed
every 2-5 minutes in emergency
• -Identification and removal of triggers: The nurse should identify and remove any triggering
stimuli, such as a full bladder, pressure ulcer, or ingrown toenail. If the triggering stimulus
cannot be removed, the nurse should attempt to alleviate the symptoms.
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Cont…
• -Positioning: The individual should be positioned in a sitting position at 90 degrees with the
head elevated and the legs lowered to reduce the risk of complications.
• Communication: The nurse should provide education to the individual and their family about
autonomic dysreflexia and how to manage it. The nurse should also ensure that the individual
has a plan in place for managing episodes of autonomic dysreflexia, including when to seek
medical attention.
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Cont…
Emotional support: The nurse should provide emotional support to the individual and their
family, as autonomic dysreflexia can be a frightening and overwhelming experience.
• Palliative nursing care of autonomic dysreflexia should be tailored to the individual's needs and
preferences. The goal is to help the individual achieve the best possible quality of life despite
their condition.
• -Comfort measures: The nurse should provide comfort measures, such as ice packs or warm
blankets, to help alleviate symptoms.
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REFERENCES
• Allen, K. J., & Leslie, S. W. (2018). Autonomic dysreflexia.
• Delhaas, E. M., Frankema, S. P., & Huygen, F. J. (2021). Intrathecal baclofen as emergency
treatment alleviates severe intractable autonomic dysreflexia in cervical spinal cord injury. The
Journal of Spinal Cord Medicine, 44(4), 617-620.
• Linsenmeyer, T. A., Gibbs, K., & Solinsky, R. (2020). Autonomic dysreflexia after spinal cord injury:
beyond the basics. Current Physical Medicine and Rehabilitation Reports, 8, 443-451.
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