AUTONOMIC HYPERREFLEXIA

AUTONOMIC HYPERREFLEXIA

(AUTONOMIC DYSREFLEXIA)

• fatal emergency unique to spinal cord injured patient
• a/c,massive, disordered autonomic (sympathetic) response to specific stimuli in patients with spinal cord injury above T6 -8 level (sympathetic outflow)
• chance of occurrence
  • cervical cord injury 60%
  • thoracic cord injury 20%
• stimuli can be
  • bladder / bowel distension (MC)
  • skin stimuli (pressure ulcer/sun burn)
  • other causes (menstrual clamps, labor, sexual stimuli etc.)
  • lower urinary tract instrumentation, catheter change, catheter obstruction
  • clot retention
• condition resolves quickly if stimulus with drawn

Pathophysiology

• stimuli carried by intact peripheral sensory nerves to spinal cord
• this stimulates sympathetic plexus
• leads to peripheral vasoconstriction – BP increases
• baroreceptors respond to increased BP – sends message to brain stem
• brainstem in turn stimulates vagus – decreased heart rate and inhibit sympathetic message via spinal cord
• inhibitory message can not reach sympathetic system as cord is injured – BP remains elevated
  
  
   
  
  

Clinical features

• stuff nose, nasal obstruction
• ponding headache
• increased BP, bradycardia, arrhythmia
• flushing of body above the level of cord injury with sweating
• blurring of vision
• cerebral hemorrhage or seizure d/t increased BP
• MI
• potentially fatal but reverse quickly if stimuli withdrawn

Treatment

• remove stimuli quickly
• sublingual nifedipine to reduce BP
• alpha or beta adrenergic blockers for a/c management
• prevent further occurrence

Prevention

• frequent pressure relief in bed / chair
• avoid sun burn / scald
• comfortable clothing
• good catheter management
• good bowel care
• endoscopic procedures done only in GA or SA
• sympathectomy / sacral neurectomy / sacral rhizotomy / cordectomy / dorsal root ganglionectomy

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