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Autonomic Dysreflexia

  • Hyun-Yoon Ko
Chapter

Abstract

Autonomic dysreflexia is a unique manifestation in people with spinal cord injury at T6 or above neurological level of injury. Episodes of autonomic dysreflexia are characterized by an acute increase in systolic blood pressure of at least 20 mmHg in individuals of spinal cord injury at or above T6 spinal cord and may or may not be accompanied by a decrease in heart beat. Autonomic dysreflexia is characterized by a sudden, massive, uninhibited reflex sympathetic discharges caused by any noxious stimuli below the lesion, and arterial blood pressure is significantly elevated. If the elevation of arterial blood pressure is so severe that it is not treated properly, it can be a life-threatening complication. Autonomic dysreflexia in the first month after spinal cord injury is rare, but cases have been reported in the first few days of injury. Autonomic dysreflexia can occur at any time from months to years after spinal shock phase.

References

  1. American Spinal Injury Association (ASIA). International standards to document remaining autonomic function after spinal cord injury (ISAFSCI). Atlanta, GA: American Spinal Injury Association; 2012.Google Scholar
  2. Armenti-Kapros B, Nambiar PK, Lippman HR, et al. An unusual cause of autonomic dysreflexia: pheochromocytoma in an individual with tetraplegia. J Spinal Cord Med. 2003;26:172–5.CrossRefGoogle Scholar
  3. Bycroft J, Shergill IS, Chung EA, et al. Autonomic dysreflexia: a medical emergency. Postgrad Med J. 2005;81:232–5.CrossRefGoogle Scholar
  4. Consortium of Spinal Cord Medicine. Autonomic dysreflexia: what you should know. Washington, DC: Paralyzed Veterans of America; 1997.Google Scholar
  5. Consortium for Spinal Cord Medicine. Acute management of autonomic dysreflexia: individuals with spinal cord injury presenting to health care facilities. 2nd ed. Washington, DC: Paralyzed Veterans of America; 2001.Google Scholar
  6. Dolinak D, Balraj E. Autonomic dysreflexia and sudden death in people with traumatic spinal cord injury. Am J Forensic Med Pathol. 2007;28:95–8.CrossRefGoogle Scholar
  7. Ekland MB, Krassioukov AV, McBride KE, et al. Incidence of autonomic dysreflexia and silent autonomic dysreflexia in men with spinal cord injury undergoing sperm retrieval: implications for clinical practice. J Spinal Cord Med. 2008;31:33–9.CrossRefGoogle Scholar
  8. Eldahan KC, Rabchevsky AG. Autonomic dysreflexia after spinal cord injury: systemic pathophysiology and methods of management. Auton Neurosci. 2018;209:59–70.CrossRefGoogle Scholar
  9. Elliott S, Krassioukov A. Malignant autonomic dysreflexia in spinal cord injured men. Spinal Cord. 2006;44:386–92.CrossRefGoogle Scholar
  10. Furlan JC, Fehlings MG. Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus. 2008;25:E13.CrossRefGoogle Scholar
  11. Gao SA, Ambring A, Lambert G, et al. Autonomic control of the heart and renal vascular bed during autonomic dysreflexia in high spinal cord injury. Clin Auton Res. 2002;12:457–64.CrossRefGoogle Scholar
  12. Guttmann L, Whitteridge D. Effects of bladder distention on automatic mechanisms after spinal cord injuries. Brain. 1947;70:361.CrossRefGoogle Scholar
  13. Head H, Riddock G. The automatic bladder, excessive sweating and some other reflex conditions in gross injuries of the spinal cord injuries of the spinal cord. Brain. 1917;40:188.CrossRefGoogle Scholar
  14. Helkowski WM, Ditunno JF Jr, Boninger M. Autonomic dysreflexia: incidence in persons with neurologically complete and incomplete tetraplegia. J Spinal Cord Med. 2003;26:244–7.CrossRefGoogle Scholar
  15. Kewalramani LS. Autonomic dysreflexia in traumatic myelopathy. Am J Phys Med. 1980;59:1–21.PubMedGoogle Scholar
  16. Kirshblum SC, House JG, O’Connor KC. Silent autonomic dysreflexia during a routine bowel program in persons with traumatic spinal cord injury: a preliminary study. Arch Phys Med Rehabil. 2002;83:1774–6.CrossRefGoogle Scholar
  17. Krassioukov A, Claydon VE. The clinical problems in cardiovascular control following spinal cord injury: an overview. Prog Brain Res. 2006;152:223–9.CrossRefGoogle Scholar
  18. Krassioukov A, Warburton DE, Teasell R, et al. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabil. 2009;90:682–95.CrossRefGoogle Scholar
  19. Lee BY, Karmakar MG, Herz BL, et al. Autonomic dysreflexia revisited. J Spinal Cord Med. 1995;18:75–87.CrossRefGoogle Scholar
  20. Linsenmeyer T, Campagnolo D, Chou I. Silent autonomic dysreflexia during voiding in men with spinal cord injuries. J Urol. 1996;55:519–22.CrossRefGoogle Scholar
  21. Mathias CJ, Frankel HL. Clinical manifestations of malfunctioning sympathetic mechanisms in tetraplegia. J Auton Nerv Syst. 1983;7:303–12.CrossRefGoogle Scholar
  22. McLachlan EM. Diversity of sympathetic vasoconstrictor pathways and their plasticity after spinal cord injury. Clin Auton Res. 2007;17:6–12.CrossRefGoogle Scholar
  23. McMahon D, Tutt M, Cook AM. Pharmacological management of hemodynamic complications following spinal cord injury. Orthopedics. 2009;32:331.CrossRefGoogle Scholar
  24. Partida E, Mironets E, Hou S, et al. Cardiovascular dysfunction following spinal cord injury. Neural Regen Res. 2016;11:189–94.CrossRefGoogle Scholar
  25. Schmitt J, Adler R. Endocrine metabolic consequences of spinal cord injury. Phys Med Rehabil State Art Rev. 1987;1:425–41.Google Scholar
  26. Sharif H, Hou S. Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury. Neural Regen Res. 2017;12:1390–400.CrossRefGoogle Scholar
  27. Sheel AW, Krassioukov AV, Inglis JT. Autonomic dysreflexia during sperm retrieval in spinal cord injury: influence of lesion level and sildenafil citrate. J Appl Physiol (1985). 2005;99:53–8.CrossRefGoogle Scholar
  28. Teasell RW, Arnold MO, Krassioukov A, et al. Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury. Arch Phys Med Rehabil. 2000;81:506–16.CrossRefGoogle Scholar
  29. Valles M, Benito J, Portell E, et al. Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient. Spinal Cord. 2005;43:738–40.CrossRefGoogle Scholar
  30. Weaver LC. What causes autonomic dysreflexia after spinal cord injury? Clin Auton Res. 2002;12:424–6.CrossRefGoogle Scholar
  31. West CR, Mills P, Krassioukov AV. Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: a meta-analysis. Spinal Cord. 2012;50:484–92.CrossRefGoogle Scholar
  32. Yoon JA, Shin YB, Shin MJ, et al. Cardiovascular monitoring during video urodynamic studies in persons with spinal cord injury. Am J Phys Med Rehabil. 2018;97:1–6.CrossRefGoogle Scholar
  33. Cardenas DD, Dalal K, editors. Spinal cord injury rehabilitation, Physical medicine and rehabilitation clinics of North America. Philadelphia, PA: Elsevier; 2014.Google Scholar

Suggested Reading

  1. Afifi AK, Bergman RA. Functional neuroanatomy: text and atlas. 2nd ed. New York: Lange Medical Books/McGraw-Hill; 2005.Google Scholar
  2. American Spinal Injury Association. International standards for neurological classification of spinal cord injury. Revised 2011. Updated 2015 edn. Atlanta, GA: American Spinal Injury Association; 2015.Google Scholar
  3. Buchanan LE, Nawoczenski DA, editors. Spinal cord injury-concepts and management approaches. Baltimore, MD: Williams & Wilkins; 1987.Google Scholar
  4. Byrne TN, Benzel EC, Waxman SG. Diseases of the spine and spinal cord. Oxford: Oxford University Press; 2000.Google Scholar
  5. Cardenas DD, Dalal K, editors. Spinal cord injury rehabilitation, Physical medicine and rehabilitation clinics of North America. Philadelphia, PA: Elsevier; 2014.Google Scholar
  6. Cardenas DD, Hooton TM, editors. Medical complications in physical medicine and rehabilitation. New York: Demos Medical Publishing, LLC; 2015.Google Scholar
  7. Chhabra HS, editor. ISCoS textbook on comprehensive management of spinal cord injuries. New Delhi: Wolters Kluwer; 2015.Google Scholar
  8. Eltorai IM, Schmit JK, editors. Emergencies in chronic spinal cord injury patients. New York: Eastern Paralyzed Veterans Association; 2001.Google Scholar
  9. Guttmann L. Spinal cord injuries. Comprehensive management and research. Oxford: Blackwell Scientific Publications; 1976.Google Scholar
  10. Illis LS, editor. Spinal cord dysfunction: assessment. Oxford: Oxford University Press; 1988.Google Scholar
  11. Jallo J, Vaccaro AR, editors. Neurotrauma and critical care of the spine. 2nd ed. New York: Thieme; 2018.Google Scholar
  12. Kirshblum S, Campagnolo DI, editors. Spinal cord medicine. 2nd ed. Philadelphia, PA: Wolters Kluwer, Lippincott, Williams & Wilkins; 2011.Google Scholar
  13. Ko HY. Manual of spinal cord medicine for physiatrists (in Korean). Seoul: Koonja; 2016.Google Scholar
  14. Lee BY, Ostrander LE, editors. The spinal cord injured patient. 2nd ed. New York: Demos; 2002.Google Scholar
  15. Lin VW. Spinal cord medicine. Principles and practice. 2nd ed. New York: Demos Medical; 2010.Google Scholar
  16. Robertson D, Bigaaioni I, Burnstock G, et al. Primer on the autonomic nervous system. 3rd ed. London: Elsevier; 2011.Google Scholar
  17. Sabharwal S. Essentials of spinal cord medicine. New York: Demos Medical; 2014.Google Scholar
  18. Verhaagen J, McDonald JW III. Spinal cord injury. In: Aminoff MJ, Boller F, Swaab DF, editors. Handbook of clinical neurology, 3rd series, vol. 109. London: Elsevier; 2012.Google Scholar
  19. Vinken PJ, Bruyn GW, editors. Injuries of the spine and spinal cord. Part I. Handbook of clinical neurology, vol. 25. Oxford: North-Holland Publishing Company; 1976a.Google Scholar
  20. Vinken PJ, Bruyn GW, editors. Injuries of the spine and spinal cord. Part II. Handbook of clinical neurology, vol. 25. Oxford: North-Holland Publishing Company; 1976b.Google Scholar
  21. Vogel LC, Zebracki K, Betz RR, Mulcahey MJ, editors. Spinal cord injury in the child and young adult. London: Mac Keith Press; 2014.Google Scholar
  22. Watson C, Paxinos G, Kayalioglu G, editors. The spinal cord. A Christopher and Dana Foundation text and atlas. New York: Elsevier; 2009.Google Scholar
  23. Weaver LC, Polosa C, editors. Autonomic dysfunction after spinal cord injury, Progress in brain research, vol. 152. New York: Elsevier; 2006.Google Scholar
  24. Weidner N, Rupp R, Taney KE, editors. Neurological aspects of spinal cord injury. Cham: Springer; 2017.Google Scholar
  25. Young RR, Woolsey RM, editors. Diagnosis and management of disorders of the spinal cord. Philadelphia, PA: W. B. Saunders; 1995.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Hyun-Yoon Ko
    • 1
  1. 1.Department of Rehabilitation MedicineRehabilitation Hospital, Pusan National University Yangsan Hospital, Pusan National University School of MedicineYangsanSouth Korea

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