Introduction[edit | edit source]Autonomic Dysreflexia (AD) is a common life-threatening condition after a Spinal Cord Injury (SCI), usually occurred if SCI is at or above the T6 level. AD is characterized by a sudden, exaggerated reflexive increase in blood pressure in response to a noxious stimulus, commonly bladder or bowel distension, arising below the neurological level of injury (NLI) [1]. Show
[2] Signs & Symptoms[edit | edit source]Acute autonomic dysreflexia is characterized by
Pathophysiology[edit | edit source]
Etiology[edit | edit source]The cause of this condition is a spinal cord injury, commonly at or above the T6 level. In the examination, an AD episode has described an increase in systolic blood pressure of at least 20-40 mm Hg or more above baseline[4]. A severe episode would usually have a systolic blood pressure of at least 150 mmHg or more than 40mmHg above the patient's baseline. The higher the injury level, the greater the severity of the cardiovascular dysfunction. The severity and frequency of autonomic dysreflexia episodes are also associated with the severity of the spinal cord injury as well as the level. Patients with a complete spinal cord injury are more than three times more likely to develop autonomic dysreflexia than those with incomplete injuries (91% to 27%)[6]. Autonomic dysreflexia does not develop until after the period of spinal shock when reflexes have recovered[4]. The earliest reported case appeared on the fourth-day post-injury. Most of the patients (92%) who will ultimately develop autonomic dysreflexia will do so within the first year after their injury. The six "B"s that are the common triggers of autonomic dysreflexia[1]:
Bladder distention is the most common cause for about 85% of all cases and is by far the most common trigger followed by fecal impaction[7]. Diagnosis[edit | edit source]The most common initial complaint is a severe throbbing headache. If the patient with spinal cord injury (spinal cord injury at or above the T6 level) complains of a severe headache, the practitioner should immediately have their blood pressure checked. If BP is elevated, a provisional diagnosis of autonomic dysreflexia can be made. The diagnosis can also be made by obtaining a history of previous autonomic dysreflexia episodes with the triggering event if known, monitoring vital signs, and watching for any developing signs and symptoms. Many patients with spinal cord injuries will have hypotension. Orthostatic hypotension is found in over 50% of patients with autonomic dysreflexia[8]. Fortunately, most episodes are relatively mild and can be managed at home by the patient and their usual caregivers without acute medical intervention[3]. Epidemiology[edit | edit source]Autonomic dysreflexia affects 48% to 70% of patients with a spinal cord injury above the T6 level and is not very common to affect if the injury is below T10 in patients with spinal cord injury[5]. Guillain–Barré Syndrome may also cause autonomic dysreflexia[9]. Physiotherapy Management[edit | edit source]In the event of an episode, the physiotherapist should perform the following steps:
Note: If the Clinician cannot find the triggering stimulus and above-mentioned steps do not manage the systolic blood pressure below 150 mmHg or less than 40 mmHg above the patient's usual baseline, the clinician should immediately inform the medical staff (doctor or nurse) . Complications[edit | edit source]Common complications of Autonomic Dysreflexia are:
Prognosis[edit | edit source]The prognosis of autonomic dysreflexia is good if the condition is identified early, and sufficient education is provided to the patient with spinal cord injury and caregivers. Differential Diagnosis[edit | edit source]
Resources[edit | edit source]An excellent free informational website devoted to patient and professional education about spinal cord injuries can be found at the International Spinal Cord Society (ISCoS) website e-learning modules. It provides educational modules designed for all stages and levels of spinal cord injury for both laypersons and healthcare personnel[4]. [11] References[edit | edit source]
Which clinical condition is caused by spinal cord injury?An injury higher on the spinal cord can cause paralysis in most of the body and affect all limbs (called tetraplegia or quadriplegia). A lower injury to the spinal cord may cause paralysis affecting the legs and lower body (called paraplegia).
What assessment findings are associated with injuries of the spinal cord at the thoracic level?The following may be associated with thoracic spine nerve damage:. Significant leg weakness or loss of sensation.. Loss of feeling in genitals or rectal region.. No control of urine or stool.. Fever and lower back pain.. A fall or injury that caused the pain.. Which condition is a patient at risk for following cervical spinal cord injury?Autonomic dysreflexia (AD) is a condition that is specific to people with a spinal cord injury (SCI). Any person who has an injury in the cervical spine or the thoracic spine at or above T6 is at risk for developing AD.
Which finding would alert the nurse that a patient with a spinal cord injury is experiencing autonomic dysreflexia?9. In autonomic dysreflexia, the nurse would expect what finding below the site of the spinal cord injury? The answer is B. The lower extremities would be cool and pale due to vasconstriction caused by the exaggerated reflex response of the sympathetic nervous system from an irritating stimulus.
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