see: [Hayes' - Autonomic dysreflexia](x-devonthink-item://FD6F392D-994D-457D-9603-64B973B1F5E2) > A serious, potentially life-threatening condition in pts with spinal cord lesions **above level of T6**. caused by a **noxious stimulus** (usually below level of injury) producing widespread **sympathetic hyperactivity** with marked [[Hypertensive Emergency|hypertension]]. - **Autonomic dysreflexia** is a potentially dangerous clinical syndrome that develops in individuals with spinal cord injury, resulting in acute, uncontrolled **hypertension**. - Develops in individuals with a neurologic level of spinal cord injury at or above the sixth thoracic vertebral level (**T6**). - Causes an imbalanced reflex sympathetic discharge, leading to potentially life-threatening hypertension, although mortality is rare. - It is considered a medical emergency and must be recognised immediately. If left untreated, autonomic dysreflexia can cause - Hypertensive encephalopty: - [[Seizures]] - [[intracerebral haemorrhage|ICH]] - confusion - retinal hemorrhage - pulmonary edema - renal insufficiency - myocardial infarction - death - Complications associated with autonomic dysreflexia *result directly from sustained, severe peripheral hypertension*. - Episodes of autonomic dysreflexia can be triggered by **many potential causes**. Essentially, ==any painful, irritating, or even strong stimulus below the level of the injury can cause an episode of autonomic dysreflexia==. **Bladder distension** or irritation is responsible for 75-85% of the cases. > lesions below T6 usually do not cause serious cardiovascular complications because parasymathetic stimulation of the greater splanchnic nerve causes mesenteric vasodilation. ## causes - ==bladder distension== - most common - constipation -- second most common - UTI - renal colic - infected pressure sore - DVT or PE - medications eg symathomimetic agents - ingrown toenail ![[Pasted image 20241107154806.png]] ## assessment - hypertension -- hallmark feature - normal SBP for this demographic is commonly fairly low eg 90/60 sitting, so even mild HTN may be abnormally elevated - can rapidly rise to 220/140 if untreated - reflex vagal effects eg bradycardia - flushed, sweat skin above level of lesion; cool pale skin below level - may have headache, blurred vision, anxiety ![[Pasted image 20241107153947.png|autonomic dysreflexia flush]] ## treatment The treatment for this is primarily supportive by addressing causative factors, such as bladder distention, pain, and hydration status. antihypertensives: - [[GTN]] -- s/l to start with - *nifedipine* 10mg po if contraindication (IR, not slow release) - +/- hydralazine place patient in sitting position