Because of legal restrictions, MOMSCIS cannot give specific medical advice. The following information is not a substitute for the personal care or advice of your physician. Please discuss any concerns with your physician regarding your medical care. Physicians in the Physical Medicine & Rehabilitation Department at the University of Missouri-Columbia are available to evaluate patient records, and can set up a clinic visit for a medical evaluation. The PM&R Department does extensive treatment of individuals with spinal cord injuries using a wide variety of physical therapies and state-of-the-art medications. Individuals with spinal cord injuries can be examined and treated on an outpatient or inpatient basis. For more information about the PM&R services available or to schedule a clinic visit, telephone the clinic at (573) 884-0033.

Autonomic Dysreflexia
What it is, what it does, and what to do if you experience it

You have a pounding headache. You have goosebumps. Your neck and face are flushed. What's going on??? If you have a spinal cord injury at the T-6 level or above, you may be experiencing symptoms of autonomic dysreflexia. In some cases, individuals whose injury is at the T-10 level or above also may experience autonomic dysreflexia. Other symptoms of autonomic dysreflexia may include: sweating, nasal congestion, slow heartbeat, blurred vision, and nausea.

Autonomic dysreflexia is the body's reaction to misinterpreted sensations (usually painful) from below the injury site. Because nerve messages about sensations cannot reach the brain through the spinal cord, the messages are sent via the autonomic nerves (those not in the spinal column). This can result in an autonomic reflex, which can cause blood vessels to constrict and raise blood pressure. In response to the high blood pressure, the brain sends messages to blood vessels to dilate but, because of the spinal cord injury, the messages are not received. The blood pressure remains high and, if not lowered quickly, can lead to stroke and death.

The most likely causes of autonomic dysreflexia are an overfull bladder and impacted stool in the rectum. Other causes include pressure sores, cuts, bruises, burns, broken bones, ingrown toenails, and tight clothing. Infections, intercourse that would be painful if sensation was present, and severe menstrual cramps can also trigger autonomic dysreflexia as can labor and delivery and procedures such as gynecological exams.

If you experience symptoms of autonomic dysreflexia, do not lie down. You should have your blood pressure evaluated immediately, especially if you experience pounding headaches. An increase of 20 or more above your normal systolic blood pressure (top number) indicates autonomic dysreflexia; blood pressure above 150/100 indicates severe autonomic dysreflexia. If you cannot take your blood pressure yourself or do not have someone who can quickly take your blood pressure, call for emergency care and inform your care provider that you may be experiencing autonomic dysreflexia. Remain sitting upright if you are transported.

If you are waiting to be evaluated or you know you are experiencing autonomic dysreflexia, take steps to identify and alleviate the cause. Sit up and lower your legs to reduce your blood pressure. Loosen any tight clothing. Check to make sure your urine collection bag isn't full. If it is, change it and keep your bag lower than your bladder. Does urine flow from your catheter? If not, check your catheter for kinks or plugs. Unkink the catheter and irrigate it. If urine doesn't start flowing within 3 minutes, change your catheter and slowly allow urine to flow. A slow urine flow prevents bladder spasms, which could make autonomic dysreflexia worse.

If an overfull bladder doesn't seem to be causing your symptoms, check your rectum for impacted stool and manually remove the stool. If your symptoms get worse or began during your bowel program, stop manual stool removal and apply a numbing ointment, like Xylocaine gel, to your rectum before continuing to remove stool.

If impacted stool isn't causing your autonomic dysreflexia, look for sores and other ailments that could be causing it. If you cannot find the cause, contact your care provider immediately. Inform your care provider that you believe you are experiencing autonomic dysreflexia. A physician can prescribe medications to lower your blood pressure while the cause of the autonomic dysreflexia is determined.

Because some care providers may be unfamiliar with autonomic dysreflexia, you may want to refer them the Paralyzed Veterans of America (PVA), (800) 860-7244 or PVA's web site, http://www.pva.org, for a treatment plan. Without proper treatment, your autonomic dysreflexia will get worse. Timely treatment is critical and can save your life.