Recognizing Signs of Autonomic Dysreflexia in Spinal Cord Injury

Recognizing Signs of Autonomic Dysreflexia in Spinal Cord Injury

As is the case with many spinal cord injury (SCI) symptoms, autonomic dysreflexia (AD) has a disappointing lack of literature for public record, and can often go unrecognized by not only patients, but by medical professionals too! It isn’t uncommon to find doctors and other professionals focussing on a “cardiac diagnosis and management of patients with AD, missing the true cause entirely.”

This potentially life-threatening condition usually affects people with spinal cord injuries at T6 or higher, although in rare conditions, individuals with T7 and T8 injuries can develop AD too. Fortunately, AD is easily treated and prevented, however recognizing the signs is critical and much less easy than the treatment itself.

What is Autonomic Dysreflexia?

Autonomic dysreflexia happens when a noxious stimulus is detected below the level of injury. This could be situations such as a blocked catheter or a bowel distension. When this happens, it triggers extreme hypertension, which is the name given when an individual experiences a severe increase in blood pressure. This can lead to fatal conditions, such as stroke, seizures, hemorrhage and even death.

Researchers encourage medical students to remember the main potential AD triggers using ‘the 6 Bs’- bladder, bowels, boils, bones, babies and back passage. Although this may sound a bit crude, these encompass and summarize potential triggers and can be helpful for individuals to recognize symptoms in themselves.


You may have heard of this term in the sporting world, and it hit headlines in the London 2012 Paralympic Games, when this dangerous practice of self-triggering AD to enhance performance was discussed. Studies suggest athletes in wheelchairs can see up to a 10% improvement in races. Some people even inflicted pain to the lower parts of their bodies in order to elevate blood pressure.  

“It's an extreme thing to do and we have to constantly remind athletes it's very dangerous,” said Craig Spence, a spokesman for the International Paralympic Committee.

So, how can I recognize the signs of AD?

There are many signs of AD, but these can sometimes be brushed off as insignificant. The key thing is to learn your baseline blood pressure, along with the triggers and symptoms.

Here is a list of potential symptoms you should keep an eye out for:

  • Nasal stuffiness
  • Very high blood pressure
  • Sudden onset pounding, throbbing, and severe headache
  • Extreme sweating above the level of injury
  • Flushed face
  • Nausea
  • Slow pulse

Of course, just because you experience one or two of these symptoms, it doesn’t necessarily mean you’re suffering from early signs of AD, and everyone will experience it slightly differently, but it is safest to just be aware. If you are feeling unwell with any of these symptoms, it is advised you contact a doctor or specialist for professional medical consultation.

If you have an SCI, it is in your best interest to familiarize yourself with AD, and make your close friends and family aware of what are the symptoms and best courses of action for suspected diagnoses. Some people with disabilities even choose to carry a small card with information on in their wallet or purse, to empower them in their ability to communicate their condition when help is needed.

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Topics: Spinal Cord Injury

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