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What is the syndrome of autonomic dysreflexia observed in tetraplegics?
Traumatic spinal cord lesions result in markedly abnormal cardiovascular, thermoregulatory, bladder, bowel, and sexual function.
In a recently injured tetraplegic in spinal shock, tactile or painful stimuli originating below the level of the lesion induce no change in blood pressure or heart rate.
In the chronic stages of spinal cord injury at the level of T6 and above, however, there is an exaggerated rise in the systolic and diastolic blood pressure, accompanied by bradycardia.
Transient tachycardia may precede the drop in heart rate. The plasma NE levels are only marginally elevated.
The marked hypertension may lead to neurologic complications, including seizures, visual defects, and cerebral hemorrhage.
This uncommon but potentially life-threatening phenomenon, called autonomic dysreflexia, is caused by the increased activity of target organs below the lesion supplied by sympathetic and parasympathetic nerves lacking supraspinal modulation.
Other clinical manifestations of autonomic dysreflexia include headache, chest tightness and dyspnea, pupillary dilation, cold limbs, flushing of face and neck, excessive sweating of the head, penile erection and discharge of seminal fluid, and contraction of bladder and bowel.
What is the best management of this condition?
The prolonged episodes of this syndrome may be prevented if the precipitating cause (e.g., painful tactile or visceral urinary and rectal stimuli) is corrected.
It is important that the bladder be emptied before performing any procedure on tetraplegic patients.
Blood pressure can often be decreased by elevating the head of the bed.
