Autonomic dysreflexia (AD) is a potentially life-threatening complication affecting individuals with spinal cord injuries at T6 level and above. This medical emergency requires ongoing vigilance and appropriate management throughout life.

What Is Autonomic Dysreflexia?

Autonomic dysreflexia occurs when a stimulus below the injury level triggers an uncontrolled autonomic nervous system response. The body cannot properly regulate blood pressure, causing dangerous spikes.

How It Develops

  1. A noxious stimulus occurs below the injury level (full bladder, bowel impaction, pressure sore)
  2. Pain signals travel up the spinal cord
  3. Below the injury, blood vessels constrict dramatically
  4. Above the injury, the body cannot send signals to relax vessels
  5. Blood pressure rises to dangerous levels—200/100 mmHg or higher

Symptoms of Autonomic Dysreflexia

  • Severe headache—often pounding
  • Flushing and sweating above injury level
  • Goosebumps below injury level
  • Nasal congestion
  • Blurred vision
  • Anxiety and feeling of impending doom
  • Slow heart rate (though heart rate may be normal or elevated)

Blood pressure reading confirms the diagnosis. Normal blood pressure for SCI survivors is often lower than typical, so readings of 150/100 may already be dangerous.

Common Triggers

Bladder Problems (Most Common)

  • Full or distended bladder
  • Blocked catheter
  • Urinary tract infection
  • Bladder stones

Bowel Problems

  • Constipation or impaction
  • Hemorrhoids
  • Bowel distension

Skin Issues

  • Pressure sores
  • Ingrown toenails
  • Burns (including sunburn)
  • Tight clothing or straps

Other Triggers

  • Sexual activity
  • Menstrual cramps
  • Labor and delivery
  • Medical procedures
  • Fractures

Dangers of Untreated AD

Autonomic dysreflexia is a medical emergency. Untreated, it can cause:

  • Stroke
  • Seizure
  • Heart attack
  • Retinal hemorrhage
  • Pulmonary edema
  • Death

Emergency Treatment

  1. Sit up immediately—lowers blood pressure using gravity
  2. Loosen all tight clothing
  3. Check bladder—empty catheter or straight catheterize
  4. Check bowel—if bladder not the cause, check for impaction
  5. Monitor blood pressure every 5 minutes
  6. If BP remains elevated, seek emergency care

Medications like nitroglycerin paste or nifedipine may be prescribed for emergency use.

Impact on Legal Cases

Lifetime Medical Costs

AD management requires:

  • Medications for emergency use and prevention
  • Blood pressure monitoring equipment
  • Emergency department visits when episodes occur
  • Caregiver training on recognition and response
  • Regular medical monitoring

Care Requirements

AD is a key reason high-level SCI survivors need trained caregivers:

  • Caregivers must recognize symptoms
  • Must know emergency response protocol
  • Must maintain proper bladder and bowel programs
  • May need medical training for emergency medication administration

Pain and Suffering

AD episodes contribute to pain and suffering:

  • Fear of potentially fatal episodes
  • Anxiety about triggers
  • Physical suffering during episodes
  • Lifestyle restrictions to avoid triggers

Prevention

Proper care reduces AD risk:

  • Regular bladder emptying schedule
  • Effective bowel program
  • Skin protection and monitoring
  • Avoiding known triggers
  • Caregiver education

Prevention requires ongoing vigilance and proper equipment—all compensable expenses.

Conclusion

Autonomic dysreflexia is a lifelong risk for individuals with high-level spinal cord injuries. The need for trained caregivers, emergency equipment, and ongoing medical monitoring are compensable damages. Life care plans must address AD prevention and management costs.