Looking back on the first time I experienced autonomic dysreflexia, I remember how scary the phenomenon can be, and how important it is for individuals with spinal cord injury (SCI) to be educated about it. Characterized by dangerous hypertension, or high blood pressure, autonomic dysreflexia can be life threatening to individuals with SCI.
The Autonomic Nervous System
When you have a spinal cord injury, your nervous system is disrupted. The body can’t get the memos the brain tries to send. The nervous system consists of more than just the brain and spinal cord, though. That subsystem is the central nervous system, but there’s another subsystem: the peripheral nervous system, which controls involuntary body functions such as breathing, blood flow, and heartbeat. Within that subsystem, there’s the autonomic nervous system.
The autonomic nervous system connects the brain to the internal organs. The sympathetic subsystem of the autonomic nervous system activates body processes, and the parasympathetic deactivates or lowers them. That balance is key to a body’s well-being and ultimately survival.
What does the autonomic nervous system control?
- Ability to sweat
- Speed of heartbeat/width of blood vessels
- Digestion process from your small intestine to your colon
- Bladder muscles
- When pancreas releases insulin and other hormones
- When your liver converts molecules that hold stored energy into glucose
- Arousal and orgasm
Damage to the Autonomic Nervous System
Spinal cord injuries often come with damage to the autonomic nervous system, but damage (known as autonomic neuropathy) can also be observed in individuals with nerve disorders, as well as Multiple sclerosis and Parkinson disease.
With loss of control of automatic functions most individuals don’t have to think about, comes understandable health complications: urinary incontinence, constipation, heat intolerance. Arguably the most dangerous challenge, autonomic dysfunction can alter blood pressure.
Autonomic Dysreflexia
Individuals with spinal cord injuries at or above the T-6 level are at risk of experiencing this dangerous phenomenon. Normal systolic blood pressure for individuals with SCI is in the 90-110mmHg range and a reading of 20-40mmHg above baseline may be a sign of Autonomic Dysreflexia.
Characterized by a sudden and dangerous increase in blood pressure, sometimes as high as 40 mmHg above normal, and often involving a pounding headache, flushed face, and sweating above the injury, autonomic dysreflexia occurs when the nerves below the injury constrict blood vessels in an attempt to signal the brain that something is wrong.
The brain doesn’t know what is wrong, however. What part of the body is hurt? Is skin pinched or a catheter kinked? Or maybe its an internal organ, trying to get help.
What Can You Do if Experiencing Autonomic Dysreflexia?
- Sit up
- Loosen or remove any tight clothing
- Check indwelling catheter if present; remove kinks or replace catheter
- Check bowel for constipation,
- Monitor BP every 2-5 minutes
- If systolic BP > 150mmHg instigate immediate pharmacological management: 10 mg Nifedipine sublingual or chewed or GTN spray 1-2 sprays, repeat every 20-30 min if needed
Autonomic dysreflexia can be scary: the fight or flight response has been triggered, and as an individual with paralysis, it can feel like neither are an option. If blood pressure raises too high before the threat can be found and eliminated, an individual can be at risk for stroke and even death.
It’s important to be educated about autonomic dysreflexia. Carrying a card which outlines causes, symptoms, and methods of relief can also be carried. You can print one out from this link provided by the Christopher Reeve Foundation.
Phone: