Skip to main content
PMC home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2005 Apr;81(954):232–235. doi: 10.1136/pgmj.2004.024463

Autonomic dysreflexia: a medical emergency

J Bycroft 1, I Shergill 1, E Choong 1, N Arya 1, P Shah 1
PMCID: PMC1743257  PMID: 15811886

Abstract

Autonomic dysreflexia is an important clinical diagnosis that requires prompt treatment to avoid devastating complications. The condition may present itself to all members of medical and surgical specialties, who may not be accustomed to treating it. It is the clinician's responsibility to have a basic understanding of the pathophysiology of the condition and the simple steps required to treat it.

Full Text

The Full Text of this article is available as a PDF (60.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armenti-Kapros Brenda, Nambiar Prabhakaran K., Lippman H. Robert, Levy James R. An unusual cause of autonomic dysreflexia: pheochromocytoma in an individual with tetraplegia. J Spinal Cord Med. 2003 Summer;26(2):172–175. doi: 10.1080/10790268.2003.11752537. [DOI] [PubMed] [Google Scholar]
  2. Arnold J. M., Feng Q. P., Delaney G. A., Teasell R. W. Autonomic dysreflexia in tetraplegic patients: evidence for alpha-adrenoceptor hyper-responsiveness. Clin Auton Res. 1995 Oct;5(5):267–270. doi: 10.1007/BF01818891. [DOI] [PubMed] [Google Scholar]
  3. Barton C. H., Khonsari F., Vaziri N. D., Byrne C., Gordon S., Friis R. The effect of modified transurethral sphincterotomy on autonomic dysreflexia. J Urol. 1986 Jan;135(1):83–85. doi: 10.1016/s0022-5347(17)45524-8. [DOI] [PubMed] [Google Scholar]
  4. Bateman Anne M., Goldish Gary D. Autonomic dysreflexia in multiple sclerosis. J Spinal Cord Med. 2002 Spring;25(1):40–42. doi: 10.1080/10790268.2002.11753601. [DOI] [PubMed] [Google Scholar]
  5. Beard J. P., Wade W. H., Barber D. B. Sacral insufficiency stress fracture as etiology of positional autonomic dysreflexia: case report. Paraplegia. 1996 Mar;34(3):173–175. doi: 10.1038/sc.1996.31. [DOI] [PubMed] [Google Scholar]
  6. Blackmer Jeff. Rehabilitation medicine: 1. Autonomic dysreflexia. CMAJ. 2003 Oct 28;169(9):931–935. [PMC free article] [PubMed] [Google Scholar]
  7. Braddom R. L., Rocco J. F. Autonomic dysreflexia. A survey of current treatment. Am J Phys Med Rehabil. 1991 Oct;70(5):234–241. [PubMed] [Google Scholar]
  8. Bycroft John A., Hamid Rizwan, Shah Julian, Craggs Michael. Management of the neuropathic bladder. Hosp Med. 2003 Aug;64(8):468–472. doi: 10.12968/hosp.2003.64.8.2261. [DOI] [PubMed] [Google Scholar]
  9. Cassam A. K., Llewellyn-Smith I. J., Weaver L. C. Catecholamine enzymes and neuropeptides are expressed in fibres and somata in the intermediate gray matter in chronic spinal rats. Neuroscience. 1997 Jun;78(3):829–841. doi: 10.1016/s0306-4522(96)00599-4. [DOI] [PubMed] [Google Scholar]
  10. Chancellor M. B., Erhard M. J., Hirsch I. H., Stass W. E., Jr Prospective evaluation of terazosin for the treatment of autonomic dysreflexia. J Urol. 1994 Jan;151(1):111–113. doi: 10.1016/s0022-5347(17)34884-x. [DOI] [PubMed] [Google Scholar]
  11. Chancellor M. B., Rivas D. A., Abdill C. K., Karasick S., Ehrlich S. M., Staas W. E. Prospective comparison of external sphincter balloon dilatation and prosthesis placement with external sphincterotomy in spinal cord injured men. Arch Phys Med Rehabil. 1994 Mar;75(3):297–305. doi: 10.1016/0003-9993(94)90033-7. [DOI] [PubMed] [Google Scholar]
  12. Chang C. P., Chen M. T., Chang L. S. Autonomic hyperreflexia in spinal cord injury patient during percutaneous nephrolithotomy for renal stone: a case report. J Urol. 1991 Dec;146(6):1601–1602. doi: 10.1016/s0022-5347(17)38180-6. [DOI] [PubMed] [Google Scholar]
  13. Cosman Bard C., Vu Tri T., Plowman Brian K. Topical lidocaine does not limit autonomic dysreflexia during anorectal procedures in spinal cord injury: a prospective, double-blind study. Int J Colorectal Dis. 2002 Mar;17(2):104–108. doi: 10.1007/s003840100347. [DOI] [PubMed] [Google Scholar]
  14. Eltorai I. M., Wong D. H., Lacerna M., Comarr A. E., Montroy R. Surgical aspects of autonomic dysreflexia. J Spinal Cord Med. 1997 Jul;20(3):361–364. [PubMed] [Google Scholar]
  15. Eltorai I., Kim R., Vulpe M., Kasravi H., Ho W. Fatal cerebral hemorrhage due to autonomic dysreflexia in a tetraplegic patient: case report and review. Paraplegia. 1992 May;30(5):355–360. doi: 10.1038/sc.1992.82. [DOI] [PubMed] [Google Scholar]
  16. Esmail Zahida, Shalansky Karen F., Sunderji Rubina, Anton Hugh, Chambers Keith, Fish William. Evaluation of captopril for the management of hypertension in autonomic dysreflexia: a pilot study. Arch Phys Med Rehabil. 2002 May;83(5):604–608. doi: 10.1053/apmr.2002.30911. [DOI] [PubMed] [Google Scholar]
  17. Finestone H. M., Teasell R. W. Autonomic dysreflexia after brainstem tumor resection. A case report. Am J Phys Med Rehabil. 1993 Dec;72(6):395–397. [PubMed] [Google Scholar]
  18. Furlan Julio C., Fehlings Michael G., Halliday William, Krassioukov Andrei V. Autonomic dysreflexia associated with intramedullary astrocytoma of the spinal cord. Lancet Oncol. 2003 Sep;4(9):574–575. doi: 10.1016/s1470-2045(03)01197-5. [DOI] [PubMed] [Google Scholar]
  19. Graham G. P., Dent C. M., Evans P. D., McKibbin B. Recurrent dislocation of the hip in adult paraplegics. Paraplegia. 1992 Aug;30(8):587–591. doi: 10.1038/sc.1992.119. [DOI] [PubMed] [Google Scholar]
  20. Hambly P. R., Martin B. Anaesthesia for chronic spinal cord lesions. Anaesthesia. 1998 Mar;53(3):273–289. doi: 10.1046/j.1365-2044.1998.00337.x. [DOI] [PubMed] [Google Scholar]
  21. Hamid R., Arya M., Wood S., Patel H. R. H., Shah P. J. R. The use of the Memokath stent in the treatment of detrusor sphincter dyssynergia in spinal cord injury patients: a single-centre seven-year experience. Eur Urol. 2003 May;43(5):539–543. doi: 10.1016/s0302-2838(03)00137-4. [DOI] [PubMed] [Google Scholar]
  22. Kabalin J. N., Lennon S., Gill H. S., Wolfe V., Perkash I. Incidence and management of autonomic dysreflexia and other intraoperative problems encountered in spinal cord injury patients undergoing extracorporeal shock wave lithotripsy without anesthesia on a second generation lithotriptor. J Urol. 1993 May;149(5):1064–1067. doi: 10.1016/s0022-5347(17)36297-3. [DOI] [PubMed] [Google Scholar]
  23. Karlsson A. K. Autonomic dysreflexia. Spinal Cord. 1999 Jun;37(6):383–391. doi: 10.1038/sj.sc.3100867. [DOI] [PubMed] [Google Scholar]
  24. Kewalramani L. S. Autonomic dysreflexia in traumatic myelopathy. Am J Phys Med. 1980 Feb;59(1):1–21. [PubMed] [Google Scholar]
  25. Krassioukov A. V., Weaver L. C. Morphological changes in sympathetic preganglionic neurons after spinal cord injury in rats. Neuroscience. 1996 Jan;70(1):211–225. doi: 10.1016/0306-4522(95)00294-s. [DOI] [PubMed] [Google Scholar]
  26. Krassioukov Andrei V., Furlan Julio C., Fehlings Michael G. Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity. J Neurotrauma. 2003 Aug;20(8):707–716. doi: 10.1089/089771503767869944. [DOI] [PubMed] [Google Scholar]
  27. Krassioukov Andrei V., Johns Devin G., Schramm Lawrence P. Sensitivity of sympathetically correlated spinal interneurons, renal sympathetic nerve activity, and arterial pressure to somatic and visceral stimuli after chronic spinal injury. J Neurotrauma. 2002 Dec;19(12):1521–1529. doi: 10.1089/089771502762300193. [DOI] [PubMed] [Google Scholar]
  28. Krum H., Louis W. J., Brown D. J., Howes L. G. A study of the alpha-1 adrenoceptor blocker prazosin in the prophylactic management of autonomic dysreflexia in high spinal cord injury patients. Clin Auton Res. 1992 Apr;2(2):83–88. doi: 10.1007/BF01819662. [DOI] [PubMed] [Google Scholar]
  29. Kursh E. D., Freehafer A., Persky L. Complications of autonomic dysreflexia. J Urol. 1977 Jul;118(1 Pt 1):70–72. doi: 10.1016/s0022-5347(17)57892-1. [DOI] [PubMed] [Google Scholar]
  30. Lindan R., Joiner E., Freehafer A. A., Hazel C. Incidence and clinical features of autonomic dysreflexia in patients with spinal cord injury. Paraplegia. 1980 Oct;18(5):285–292. doi: 10.1038/sc.1980.51. [DOI] [PubMed] [Google Scholar]
  31. Lindan R., Leffler E. J., Kedia K. R. A comparison of the efficacy of an alpha-I-adrenergic blocker in the slow calcium channel blocker in the control of autonomic dysreflexia. Paraplegia. 1985 Feb;23(1):34–38. doi: 10.1038/sc.1985.6. [DOI] [PubMed] [Google Scholar]
  32. McGregor J. A., Meeuwsen J. Autonomic hyperreflexia: a mortal danger for spinal cord-damaged women in labor. Am J Obstet Gynecol. 1985 Feb 1;151(3):330–333. doi: 10.1016/0002-9378(85)90297-2. [DOI] [PubMed] [Google Scholar]
  33. Moeller B. A., Jr, Scheinberg D. Autonomic dysreflexia in injuries below the sixth thoracic segment. JAMA. 1973 May 28;224(9):1295–1295. [PubMed] [Google Scholar]
  34. Perkash I. Autonomic dysreflexia and detrusor-sphincter dyssynergia in spinal cord injury patients. J Spinal Cord Med. 1997 Jul;20(3):365–370. [PubMed] [Google Scholar]
  35. Ricottone A. R., Pranikoff K., Steinmetz J. R., Constantino G. Long-term follow-up of sphincterotomy in the treatment of autonomic dysreflexia. Neurourol Urodyn. 1995;14(1):43–46. doi: 10.1002/nau.1930140108. [DOI] [PubMed] [Google Scholar]
  36. Shergill I. S., Arya M., Hamid R., Khastgir J., Patel H. R. H., Shah P. J. R. The importance of autonomic dysreflexia to the urologist. BJU Int. 2004 May;93(7):923–926. doi: 10.1111/j.1464-410X.2003.04756.x. [DOI] [PubMed] [Google Scholar]
  37. Snow J. C., Sideropoulos H. P., Kripke B. J., Freed M. M., Shah N. K., Schlesinger R. M. Autonomic hyperreflexia during cystoscopy in patients with high spinal cord injuries. Paraplegia. 1978 Feb;15(4):327–332. doi: 10.1038/sc.1977.49. [DOI] [PubMed] [Google Scholar]
  38. Soni B. M., Oo T., Vaidyanathan S., Hughes P. L., Singh G. Complications of sacral anterior root stimulator implantation in a cervical spinal cord injury patient: increased spasms requiring intrathecal baclofen therapy followed by delayed fracture of lumbar spine leading to intractable spasms compelling disuse of the sacral anterior root stimulator. Spinal Cord. 2004 Feb;42(2):136–138. doi: 10.1038/sj.sc.3101546. [DOI] [PubMed] [Google Scholar]
  39. Steinberger R. E., Ohl D. A., Bennett C. J., McCabe M., Wang S. C. Nifedipine pretreatment for autonomic dysreflexia during electroejaculation. Urology. 1990 Sep;36(3):228–231. doi: 10.1016/0090-4295(90)80261-k. [DOI] [PubMed] [Google Scholar]
  40. Szasz G., Carpenter C. Clinical observations in vibratory stimulation of the penis of men with spinal cord injury. Arch Sex Behav. 1989 Dec;18(6):461–474. doi: 10.1007/BF01541673. [DOI] [PubMed] [Google Scholar]
  41. Vaidyanathan S., Soni B. M., Sett P., Watt J. W., Oo T., Bingley J. Pathophysiology of autonomic dysreflexia: long-term treatment with terazosin in adult and paediatric spinal cord injury patients manifesting recurrent dysreflexic episodes. Spinal Cord. 1998 Nov;36(11):761–770. doi: 10.1038/sj.sc.3100680. [DOI] [PubMed] [Google Scholar]
  42. Van Kerrebroeck E. V., van der Aa H. E., Bosch J. L., Koldewijn E. L., Vorsteveld J. H., Debruyne F. M. Sacral rhizotomies and electrical bladder stimulation in spinal cord injury. Part I: Clinical and urodynamic analysis. Dutch Study Group on Sacral Anterior Root Stimulation. Eur Urol. 1997;31(3):263–271. doi: 10.1159/000474466. [DOI] [PubMed] [Google Scholar]
  43. Wright K. C., Agre J. C., Wilson B. C., Theologides A. Autonomic dysreflexia in a paraplegic man with catecholamine-secreting neuroblastoma. Arch Phys Med Rehabil. 1986 Aug;67(8):566–567. [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES