Question

Autonomic dysreflexia is an acute emergency.

7. What is autonomic dysreflexia?
8. What is the cause?
9. What are the manifestations?

Answer 1

7 ans)

= Introduction.

Autonomic dysreflexia is a condition that emerges after a spinal cord injury, usually when the injury has occurred above the T6 level. The higher the level of the spinal cord injury, the greater the risk with up to 90% of patients with cervical spinal or high-thoracic spinal cord injury being susceptible

# Definition

Autonomic dysreflexia (AD) is a condition in which your involuntary nervous system overreacts to external or bodily stimuli. It’s also known as autonomic hyperreflexia. This reaction causes:

• *a dangerous spike in blood pressure
• * slow heartbeat
• * constriction of your peripheral blood vessels
• * other changes in your body’s autonomic functions

# How autonomic dysreflexia happens in the body

To understand AD, it’s helpful to understand the autonomic nervous system (ANS). The ANS is the part of the nervous system responsible for maintaining involuntary bodily functions, such as:

• * blood pressure
• * heart and breathing rates
• * body temperature
• * digestion
• * metabolism
• * balance of water and electrolytes
• * production of body fluids
• * urination
• * defecation
• * sexual response

There are two branches of ANS:

• * sympathetic autonomic nervous system (SANS)
• * parasympathetic autonomic nervous system (PANS)

8 ans)

# Causes of AD

Autonomic dysreflexia is caused by an irritant below the level of injury, including:

• * Bladder: irritation of the bladder wall, urinary tract infection, blocked catheter or overfilled collection bag.
• * Bowel: distended or irritated bowel, constipation or impaction, hemorrhoids or anal infections.
• * Other causes include skin infection or irritation, cuts, bruises, abrasions or pressure sores (decubitus ulcers), ingrown toenails, burns (including sunburn and burns from hot water) and tight or restrictive clothing.

AD can also be triggered by sexual activity, menstrual cramps, labor and delivery, ovarian cysts, abdominal conditions (gastric ulcer, colitis, peritonitis) or bone fractures.

9ans)

The manifestations are variable and include:

• * A severe headache
• * Profuse diaphoresis above the level of injury
• * Flushing above the level of injury
• * Piloerection above the level of injury
• * Dry and pale skin because of vasoconstriction below the level of injury
• * Visual disturbances
• * Nasal stuffiness
• * Anxiety or feelings of doom
• * Nausea and vomiting

Hypertension may be asymptomatic or be severe enough to lead to a hypertensive crisis complicated by pulmonary edema, left ventricular dysfunction, retinal detachment, intracranial hemorrhage, seizures or even death. Bradycardia may also range from minor to resulting in cardiac arrest. Tachycardia is less common than bradycardia but may also occur along with cardiac arrhythmias and atrial fibrillation or flutter. If the patient has coronary artery disease, an episode may cause a myocardial infarction.

The combination of dangerously high blood pressure together with cerebral vasodilation puts the patient at high risk for a hemorrhagic stroke which can be life-threatening.

# Autonomic Dysreflexia Diagnosis

Your doctor will measure your blood pressure while they figure out what triggered your autonomic dysreflexia episode. They’ll check your bladder and bowels, since fullness or a blockage there is usually the cause of the problem.

You may need imaging tests, like X-rays or an ultrasound, or lab tests on your blood or urine.

# Autonomic Dysreflexia Treatments

If you have autonomic dysreflexia symptoms, here are a few things you can do until you can get medical help:

• * Sit up as much you can. This helps move more blood to your lower body and ease your blood pressure
• * Take off tight clothes or other irritants
• * Pee
• * Quick steps can keep the problem from getting worse. Your doctor may give you medication to make your blood pressure drop quickly. If the problem is severe, they may watch your blood pressure for 2-48 hour
• # Autonomic Dysreflexia Prevention

• You can take steps to lower your chance of complications:

• * Use the bathroom on a regular schedule. Keep your bladder and bowels from becoming too full.
• * Know the signs of a bladder infection.
• * Take care not to get skin sores or ingrown toenails.
• * Carry a card for emergencies to let people know you might have autonomic dysreflexia.

• # Autonomic Dysreflexia Complications

  Autonomic dysreflexia can be a life-threatening condition. It can cause bleeding in the brain, stroke, seizures, and other heart and lung