Autonomic Dysreflexia After Spinal Cord Injury: Beyond the Basics
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SPINAL CORD INJURY REHABILITATION (J DONOVAN, SECTION EDITOR)
Autonomic Dysreflexia After Spinal Cord Injury: Beyond the Basics Todd A. Linsenmeyer 1,2,3
&
Kathryn Gibbs 1,3 & Ryan Solinsky 4,5,6
Accepted: 8 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The purpose of this article is to update health care providers on recommended identification and management strategies for autonomic dysreflexia (AD), as well as an in-depth discussion of pharmacological management of AD. In addition, this article will focus on prevention strategies and less commonly recognized causes of AD. Recent Finding Clinical practice guidelines are available with effective evaluation and management strategies to treat individuals with spinal cord injury (SCI) presenting to health care professionals with AD. Three common yet easily overlooked causes of AD are distended urinary leg drainage bags preventing the flow of urine from the bladder, abdominal binders, and pressure injuries. Prevention strategies for those with recurrent AD include treatment with alpha-blockers. Summary Autonomic dysreflexia is a potentially life-threatening emergency which requires quick recognition, identification of the cause, and pharmacological management as the cause is being reversed. Excellent guidelines have been developed for the evaluation and management of AD. Keywords Spinal cord injury . Autonomic dysreflexia . Clinical practice guideline
Introduction Definition and Pathophysiology of Autonomic Dysreflexia Although the definition for AD has evolved over time, it is currently defined by The International Standards for Documentation of Remaining Autonomic Function after SCI [1•]. AD is a constellation of signs and/or symptoms This article is part of the Topical Collection on Spinal Cord Injury Rehabilitation * Todd A. Linsenmeyer [email protected] 1
Department of Urology, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
2
Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA
3
Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
4
Spaulding Rehabilitation Hospital, Boston, MA, USA
5
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
6
Spaulding Research Institute, Boston, MA, USA
in individuals with SCI at, and usually above, T6 in response to noxious or non-noxious stimuli below the level of injury, defined by an increase in systolic blood pressure (SBP) > 20 mmHg above baseline. This condition may or may not be symptomatic and may occur at any period following SCI [2]. The phenomenon is due to an uncontrolled sympathetic response triggered by a stimulus below the level of injury. This stimulus is typically noxious and may be unperceived by the individual, such as a full bladder or mild constipation. Due to the significant elevation in SBP that occurs with AD, it can be a potentially lifethreat
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