Overview
Recognize the Emergency Pattern
Autonomic dysreflexia (AD) is a hypertensive neurological emergency that can occur after spinal cord injury, most often when the lesion is at or above T6.
Autonomic dysreflexia (AD) is a hypertensive neurological emergency that can occur after spinal cord injury, most often when the lesion is at or above T6. The defining change is a sudden systolic blood pressure increase of at least 20 mmHg above the person’s known baseline. The absolute pressure may not initially look extreme; the change from that person’s usual pressure is what matters. Typical findings include a pounding headache, hypertension, flushing or sweating above the injury, nasal congestion, visual disturbance, and reflex bradycardia. The skin below the lesion may be pale, cool, or dry. Pain may be absent because sensation below the injury is impaired, so a patient who denies pain can still have AD. An experienced nurse notices the combination rather than waiting for every symptom: a high-risk spinal cord injury, an abrupt blood pressure rise, and a possible stimulus below the lesion. Treat that pattern immediately. Severe or persistent hypertension can lead to neurological and cardiovascular complications.