Getting Familiar with Autonomic Dysreflexia (AD)

An emergency issue in paralysis is Autonomic Dysreflexia more often called AD. This can occur in individuals with spinal cord injury from trauma OR disease, or with head injury. It is a condition where an individual’s blood pressure suddenly rises to or above 20mm Hg (mercury) in adults or 15 mm Hg in children over their normal blood pressure. That is 20 points or higher in adults and 15 points higher or more in children in the top number of the individual’s normal average blood pressure.

arm getting blood pressure taken

AD occurs because something is irritating the individual in the paralyzed part of the body. This message is not clearly sent or interpreted by the brain resulting in an ‘all out’ release of messages from the brain to try to resolve the unclear issue. The result is an elevation in blood pressure which can have damaging effects on the cardiovascular system including the heart and blood vessels. Left untreated, AD can result in stroke or even death.

AD can occur in individuals with spinal cord injury at or above T6 but has been noted in those with injuries as low as T10. Not everyone with spinal cord injury will have AD. It develops after spinal shock resolves which can be up to six months after injury. In those with spinal cord injury from disease, AD may or may not develop as the disease progresses. In head injury, AD occurs if the autonomic nervous system is affected.

New research has demonstrated that individuals can have silent AD where the blood pressure rises but no symptoms are felt. Silent AD can even occur when sleeping.

Know your individual blood pressure by measuring it at home during various activities. Have it measured by someone even occasionally when asleep. Your individual average will become apparent. That way you will know when your blood pressure is suddenly elevated over your normal.

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Triggers of Autonomic Dysreflexia include the six ‘B’s.

  1. Bladder-anything that stops the free flow of urine including catheter kinking or blockage, stones, infection, spasms, clots, overdistension
  2. Bowel-constipation, diarrhea, impaction
  3. Back passage-hemorrhoids, fistulas, diverticulitis, abscess, fissure
  4. Boils-pressure injury, sores, anything bothering the skin, wrinkled sheets, too tight clothing or straps on a leg bag, shoes, braces or splints rubbing (boils is an unfortunate choice of words but the b fits the pneumonic)
  5. Bones-broken bones, dislocations, bunions, joints rubbing or misalignments
  6. Babies-different stages of pregnancy can trigger an AD episode as can delivery

Nurse Linda’s 7 symptom: Bother-anything that bothers your body can trigger AD, computer use, smells, glasses rubbing your nose, sexual activity.

There are many symptoms of AD, most people know the most common symptom of a pounding headache, but other more subtle symptoms can occur such as a stuffy nose, visual disturbance, sweating, flushing, goosebumps tingling, tightness in the chest, or difficulty breathing. You may have some or all symptoms, or no symptoms as in silent AD.

Treatment must be provided quickly:

  • Sit up suddenly
  • Loosen constrictions
  • Check bladder, bowel, and skin for disruptions
  • Monitor blood pressure every 3 minutes
  • If unresolved call 911 and go to the emergency room

Print the Christopher & Dana Reeve Foundation Wallet Card to provide to your family, healthcare professionals, EMTs, ER staff, and yourself. This is a quick overview of information that will help you get the medical care you need! 

Detailed information about AD and spinal cord injury from the PVA can be found here.

More information about autonomic dysfunction after head injury can be found here.

About the Author - Nurse Linda

Linda Schultz, Ph.D., CRRN is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

Nurse Linda

The opinions expressed in these blogs are the author's own and do not necessarily reflect the views of the Christopher & Dana Reeve Foundation.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $10,000,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, ACL/HHS, or the U.S. Government.