Autonomic dysreflexia - Revision history

Danbot: Add reference

2026-03-22T10:07:15Z

Add reference

← Older revision		Revision as of 10:07, 22 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	*Syndrome of massive imbalanced reflex sympathetic discharge from strong stimulus below level of spinal lesion		*Syndrome of massive imbalanced reflex sympathetic discharge from strong stimulus below level of spinal lesion<ref>Krassioukov A, et al. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil. 2009;90(4):682-695. PMID 19345787</ref>
	*Carotid and aortic baroreceptors result in strong vagal response with bradycardia and vasodilation above level of injury, but cannot inhibit sympathetics below level of injury - [[hypertension]] remains dysregulated by the CNS		*Carotid and aortic baroreceptors result in strong vagal response with bradycardia and vasodilation above level of injury, but cannot inhibit sympathetics below level of injury - [[hypertension]] remains dysregulated by the CNS
	*Occurring in patients with [[spinal cord injury]] (SCI) above the splanchnic sympathetic outflow (T5-T6)		*Occurring in patients with [[spinal cord injury]] (SCI) above the splanchnic sympathetic outflow (T5-T6)

ClaireLewis at 23:06, 1 October 2019

2019-10-01T23:06:07Z

← Older revision		Revision as of 23:06, 1 October 2019
Line 1:		Line 1:
	==Background==		==Background==
	*Syndrome of massive imbalanced reflex sympathetic discharge from strong stimulus below level of spinal lesion		*Syndrome of massive imbalanced reflex sympathetic discharge from strong stimulus below level of spinal lesion
	*Carotid and aortic baroreceptors result in strong vagal response with bradycardia and vasodilation above level of injury, but cannot inhibit sympathetics below level of injury - hypertension remains dysregulated by the CNS		*Carotid and aortic baroreceptors result in strong vagal response with bradycardia and vasodilation above level of injury, but cannot inhibit sympathetics below level of injury - [[hypertension]] remains dysregulated by the CNS
	*Occurring in patients with spinal cord injury (SCI) above the splanchnic sympathetic outflow (T5-T6)		*Occurring in patients with [[spinal cord injury]] (SCI) above the splanchnic sympathetic outflow (T5-T6)
	*Splanchnic innervation from T5-T9		*Splanchnic innervation from T5-T9
	*Lesions below T6 allow descending inhibitory PSNS control to decrease splanchnic tone, preventing hypertension		*Lesions below T6 allow descending inhibitory PSNS control to decrease splanchnic tone, preventing hypertension
Line 8:		Line 8:

	===Common triggers (due to strong stimuli below level of injury)===		===Common triggers (due to strong stimuli below level of injury)===
	*Bladder distension ~80%		*[[urinary retention\|Bladder distension]] ~80%
	*Bowel distension, fecal impaction ~15%		*Bowel distension, [[fecal impaction]] ~15%
	*Pressure ulcers		*[[decubitus ulcers\|Pressure ulcers]]

	==Clinical Features==		==Clinical Features==
	''Possible to be asymptomatic''		''Possible to be asymptomatic''

			*A sudden significant rise in systolic and diastolic blood pressures
			**Usually associated with [[bradycardia]]
			**SBP >140 mm Hg (in a patient with SCI above T6)

	===Unopposed PSNS above lesion===		===Unopposed PSNS above lesion===
	*Blurry vision, miosis		*[[blurred vision\|Blurry vision]], miosis
	*[[Headaches]]		*[[Headaches]]
	*[[Anxiety]]		*[[Anxiety]]
Line 31:		Line 35:

	==Evaluation==		==Evaluation==
	*A sudden significant rise in systolic and diastolic blood pressures
	**Usually associated with bradycardia
	**SBP >140 mm Hg (in a patient with SCI above T6)

	==Management==		==Management==
	~~;hypertension~~ should abate once offending agent corrected (normal = SBP 90-110 mmHg)		''Hypertension should abate once offending agent corrected (normal = SBP 90-110 mmHg)''
	#Remove offending agent		#Remove offending agent
	#*Check urinary catheter for any blockage or twisting		#*Check urinary catheter for any blockage or twisting

Rossdonaldson1: Text replacement - "HTN" to "hypertension"

2016-07-30T10:25:37Z

Text replacement - "HTN" to "hypertension"

← Older revision		Revision as of 10:25, 30 July 2016
Line 1:		Line 1:
	==Background==		==Background==
	*Syndrome of massive imbalanced reflex sympathetic discharge from strong stimulus below level of spinal lesion		*Syndrome of massive imbalanced reflex sympathetic discharge from strong stimulus below level of spinal lesion
	*Carotid and aortic baroreceptors result in strong vagal response with bradycardia and vasodilation above level of injury, but cannot inhibit sympathetics below level of injury - ~~HTN~~ remains dysregulated by the CNS		*Carotid and aortic baroreceptors result in strong vagal response with bradycardia and vasodilation above level of injury, but cannot inhibit sympathetics below level of injury - hypertension remains dysregulated by the CNS
	*Occurring in patients with spinal cord injury (SCI) above the splanchnic sympathetic outflow (T5-T6)		*Occurring in patients with spinal cord injury (SCI) above the splanchnic sympathetic outflow (T5-T6)
	*Splanchnic innervation from T5-T9		*Splanchnic innervation from T5-T9
	*Lesions below T6 allow descending inhibitory PSNS control to decrease splanchnic tone, preventing ~~HTN~~		*Lesions below T6 allow descending inhibitory PSNS control to decrease splanchnic tone, preventing hypertension
	*Medical emergency given dangerous sequelae of elevated blood pressure		*Medical emergency given dangerous sequelae of elevated blood pressure

Line 36:		Line 36:

	==Management==		==Management==
	;~~HTN~~ should abate once offending agent corrected (normal = SBP 90-110 mmHg)		;hypertension should abate once offending agent corrected (normal = SBP 90-110 mmHg)
	#Remove offending agent		#Remove offending agent
	#*Check urinary catheter for any blockage or twisting		#*Check urinary catheter for any blockage or twisting

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-21T23:35:05Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 23:35, 21 July 2016
Line 30:		Line 30:
	{{Hypertension DDX}}		{{Hypertension DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*A sudden significant rise in systolic and diastolic blood pressures		*A sudden significant rise in systolic and diastolic blood pressures
	**Usually associated with bradycardia		**Usually associated with bradycardia

Neil.m.young: Text replacement - "==Treatment==" to "==Management=="

2016-07-07T12:25:29Z

Text replacement - "==Treatment==" to "==Management=="

← Older revision		Revision as of 12:25, 7 July 2016
Line 35:		Line 35:
	**SBP >140 mm Hg (in a patient with SCI above T6)		**SBP >140 mm Hg (in a patient with SCI above T6)

	==~~Treatment~~==		==Management==
	;HTN should abate once offending agent corrected (normal = SBP 90-110 mmHg)		;HTN should abate once offending agent corrected (normal = SBP 90-110 mmHg)
	#Remove offending agent		#Remove offending agent

Rossdonaldson1: /* Clinical Features */

2016-04-28T10:56:50Z

Clinical Features

@@ Line 14: / Line 14: @@
 ==Clinical Features==
 ''Possible to be asymptomatic''
-*Profuse sweating/flushing above the level of lesion (especially in the face, neck, and shoulders)
+===Unopposed PSNS above lesion===
 ==Differential Diagnosis==

Rossdonaldson1: /* Diagnosis */

2016-04-28T10:55:58Z

Diagnosis

← Older revision		Revision as of 10:55, 28 April 2016
Line 32:		Line 32:

	==Diagnosis==		==Diagnosis==
	*Clinical diagnosis		*A sudden significant rise in systolic and diastolic blood pressures
	**A sudden significant rise in systolic and diastolic blood pressures		**Usually associated with bradycardia
	***Usually associated with bradycardia		**SBP >140 mm Hg (in a patient with SCI above T6)
	***SBP >140 mm Hg (in a patient with SCI above T6)

	==Treatment==		==Treatment==

Rossdonaldson1: /* Diagnosis */

2016-04-28T10:55:45Z

Diagnosis

← Older revision		Revision as of 10:55, 28 April 2016
Line 33:		Line 33:
	==Diagnosis==		==Diagnosis==
	*Clinical diagnosis		*Clinical diagnosis
			**A sudden significant rise in systolic and diastolic blood pressures
			***Usually associated with bradycardia
			***SBP >140 mm Hg (in a patient with SCI above T6)

	==Treatment==		==Treatment==

Rossdonaldson1: /* Clinical Features */

2016-04-28T10:55:19Z

Clinical Features

← Older revision		Revision as of 10:55, 28 April 2016
Line 26:		Line 26:
	**Piloerection, goose bumps		**Piloerection, goose bumps

	~~===Physical===~~
	*A sudden significant rise in systolic and diastolic blood pressures
	**Usually associated with bradycardia
	**SBP >140 mm Hg (in a patient with SCI above T6)
	*Profuse sweating/flushing above the level of lesion (especially in the face, neck, and shoulders)		*Profuse sweating/flushing above the level of lesion (especially in the face, neck, and shoulders)

Rossdonaldson1: /* Treatment */

2016-04-28T10:54:43Z

Treatment

← Older revision		Revision as of 10:54, 28 April 2016
Line 39:		Line 39:

	==Treatment==		==Treatment==
	;HTN should abate once offending agent corrected - normal is SBP 90-110 mmHg		;HTN should abate once offending agent corrected (normal = SBP 90-110 mmHg)
	*Check urinary catheter for any blockage or twisting		#Remove offending agent
	*If cath blocked, gently irrigate bladder with NS at body temp		#*Check urinary catheter for any blockage or twisting
	*If cath is draining, suspect fecal impaction and check rectum for stool with lidocaine jelly lube - gentle disimpaction to follow		#**If cath blocked, gently irrigate bladder with NS at body temp
	*Place in an upright position to allow gravitational pooling of blood to reduce BP		#**If cath is draining, suspect fecal impaction and check rectum for stool with lidocaine jelly lube - gentle disimpaction to follow
	*Careful inspection of nonsensate areas to identify the source of painful stimuli		#*Careful inspection of nonsensate areas to identify the source of painful stimuli
	**(e.g. catheter, restrictive clothing, leg bag straps, abdominal supports, orthoses)		#**e.g. catheter, restrictive clothing, leg bag straps, abdominal supports, orthoses
	;BP meds ~~with~~ SBP > 150~~, use~~ short-acting since offending agent must be corrected; use with caution in CAD		#Directly lower blood pressure (if #1 fails)
	*Nifedipine immediate release		#*Place in an upright position to allow gravitational pooling of blood to reduce BP
	*~~NTG paste or~~ sublingual ~~NTG~~		#*BP meds if SBP > 150
			#**Use short-acting (since offending agent must be corrected); use with caution in CAD
			#**[[Nifedipine]] immediate release
			#**[[Nitroglycerine]] sublingual

	==Disposition==		==Disposition==