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Autonomic dysreflexia

Autonomic dysreflexia
Classification and external resources
ICD-9-CM 337.3
DiseasesDB 1155
MedlinePlus 001431
eMedicine article/322809
MeSH D020211
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Autonomic dysreflexia (AD), also known as autonomic hyperreflexia, is a potentially life-threatening condition which can be considered a medical emergency requiring immediate attention. AD occurs most often in individuals with spinal cord injuries with spinal lesions above the T6 spinal cord level, although it has been known to occur in patients with a lesion as low as T10.

Acute AD is a reaction of the autonomic (involuntary) nervous system to overstimulation. It is characterized by paroxysmal hypertension (the sudden onset of severe high blood pressure) associated with throbbing headaches, profuse sweating, nasal stuffiness, flushing of the skin above the level of the lesion, slow heart rate, anxiety, and sometimes by cognitive impairment. The sympathetic discharge that occurs is usually in association with spinal cord injury (SCI) or diseases such as multiple sclerosis.

AD is believed to be triggered by afferent stimuli (nerve signals that send messages back to the spinal cord and brain) which originate below the level of the spinal cord lesion. It is believed that these afferent stimuli trigger and maintain an increase in blood pressure via a sympathetically mediated vasoconstriction in muscle, skin and splanchnic (gut) vascular beds.

This condition is distinct and usually episodic, with the people experiencing remarkably high blood pressure (often with systolic readings over 200 mm. Hg), intense headaches, profuse sweating, facial erythema, goosebumps, nasal stuffiness, a "feeling of doom" or apprehension, and blurred vision. An elevation of 40 mm Hg over baseline systolic should be suspicious for dysreflexia.


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