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COMMON COMPLICATIONS OF SPINAL CORD INJURY: AUTONOMIC DYSREFLEXIA
In people who are quadriplegic, autonomic dysreflexia (also called hyperrefiexia) indicates that the sympathetic nervous system, and thus blood pressure regulation, is out of control. It occurs only when the level of spinal cord injury is above T5 and the sympathetic nervous system – primarily responsible for controlling blood flow and blood pressure – loses important connections to the brain.
An attack of autonomic dysreflexia typically causes a severe headache coupled with very high blood pressure. Other symptoms can include blurred vision and sweating, flushing of the skin and goose bumps above the level of the spinal cord injury. It can result from almost any noxious stimulus to the body below the level of the injury.
Autonomic dysreflexia can be a medical emergency, sometimes resulting in a stroke if the blood pressure is not brought under control. Once it starts, an attack of autonomic dysreflexia is best treated by finding and removing the cause. When the cause is eliminated, the attack usually resolves almost immediately. The cause of an attack is usually one of the following:
1. Over-distention of the bladder, caused by an accumulation of too much urine. This is treated by draining the bladder.
2. Stool retained in the lower bowel. This is treated by eliminating the fecal material, which may require use of a suppository.
3. Pressure on the skin. Intermittent pressure releases will alleviate this problem. Choosing looser clothing that does not exert pressure is also recommended.
Other causes include trauma (for example, a broken bone), infection, severe menstrual cramps or contractions during labor, and temperature changes. Maintaining a reliable bowel and bladder program and protecting the skin can help prevent episodes of autonomic dysreflexia. If the cause of the dysreflexia cannot be found or eliminated, medications are required to lower the blood pressure.
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