Autonomic Dysreflexia

Autonomic Dysreflexia (AD) occurs, to at least some extent, in up to 90% of people with cervical spinal cord injury (SCI) and those with upper thoracic injury above level T6. 

AD can happen when an irritation below the level of injury occurs but the signals sent to the brain to respond to the irritant are blocked due to damage to the spinal cord. 

When the body and brain are not able to communicate effectively, a rise in blood pressure can result due to the narrowing of blood vessels. A stimulus below the level of injury can cause a reflex action that causes a narrowing of blood vessels, causing a rise in blood pressure. The brain responds to this rise in blood pressure by slowing the heart rate and enlarging blood vessels to compensate. However, only the blood vessels above the level of the spinal cord injury can receive these messages. The signal is blocked below the level of injury and the blood vessels continue to squeeze, keeping blood pressure elevated. If the blood pressure continues to rise, seizure, stroke, or even death can occur.

Signs and Symptoms of AD

There are signs and symptoms to look out for, but these can be subtle and difficult to detect even with high or extremely high blood pressure. Symptoms include: 

  • Blurred vision
  • Flushed face
  • Red blotches on the upper body
  • Nausea
  • Pounding headache
  • Nasal congestion
  • Chills (with no fever)
  • Anxiety
  • Slow pulse (less than 60 beats per minute)
  • Clammy or cool skin
  • Sweating or goosebumps above the level of injury

What Causes Autonomic Dysreflexia?

Essentially, any type of irritant or injury below the level of injury can put someone with SCI at risk. This even includes relatively benign situations such as tight or restrictive clothing, temperature changes, and bruises. In most cases, when the irritant is removed or treated AD is resolved. 

Some of the more common causes of AD include:

Bowel and bladder issues, including bladder distension, blocked catheter, urinary tract infection, constipation, hemorrhoids, and fecal impaction.

Skin conditions, including pressure ulcers, wounds, sunburn, ingrown toenails, insect bites, and skin irritation.

Abdominal conditions, including gastric ulcers and appendicitis

Women’s conditions, including menstrual cramps, pregnancy, and labor/delivery

Summer Skin Hygiene and AD

Due to the higher risk of sunburn, extreme temperatures, and the potential for skin irritants, it is essential to practice proper skin hygiene during the summer months to help prevent sunburn and skin breakdown, as both can cause AD. 

The use of barrier products (sunscreen) is vital, but make sure the barrier product is breathable (non-petroleum based) and won’t increase the risk of skin breakdown. It is important to apply sunscreen to all skin that is exposed to the sun, not only skin below the level of injury. When possible, protect skin by wearing loose-fitting clothes and check skin under dressings and wraps frequently during the heat of summer. 

Keep skin clean with hypo-allergenic skin care products that have a low pH level. Avoid antibacterial soaps and clean skin folds and creases at least twice per day. 

Bowel & Bladder Management and AD

Effective bowel and bladder management programs are one of the best preventive measures to help avoid AD because most episodes of autonomic dysreflexia are triggered by stimuli from the bowel and bladder. 

Constipation can increase in the summer, so it’s important to have a regular bowel management program to help prevent excess moisture build-up and protect skin. Proper hydration, balanced nutrition that includes proper daily fiber intake, and a fitness routine all help reduce the risk of constipation which can lead to AD.

Prevention of Autonomic Dysreflexia

Although AD is a dangerous and potentially fatal condition, it is also preventable with proper daily habits. In addition to a bowel and bladder management program, protecting the skin is essential as it is the largest organ in the body as well as the most exposed.

Ensure that skin is always well protected, especially in the sun and heat, and perform regular skin inspections to look for signs of injury or irritation. Avoid wearing tight or restrictive clothing. Wellness habits like proper hydration, good sleep hygiene, regular exercise (for those with limited mobility, stretching exercises help), and consuming a balanced diet that includes fiber all help reduce the risk of AD.

 

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Disclaimer: The material contained is for reference purposes only. Quest Products, LLC does not assume responsibility for patient care. Consult a physician prior to use. Copyright 2021 Quest Products, LLC.

 

Sources: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255181/

http://www.braininjurysupport.org/living-with-a-spinal-cord-injury/autonomic-dysreflexia/

https://www.christopherreeve.org/living-with-paralysis/health/secondary-conditions/autonomic-dysreflexia