People with a spinal cord injury (SCI) may be at risk for a serious condition called autonomic dysreflexia. If you have a spinal cord injury in the upper back (at the T6 level or above), it can cause a dangerous rise in blood pressure and a slowing of the heart rate.

Understanding autonomic dysreflexia:

Autonomic dysreflexia is uncommon during the first month after a spinal cord injury, but it often appears within the first year. It usually occurs in episodes triggered by irritation below the level of the spinal cord injury. Even minor triggers, such as a full bladder, can cause an abnormal response in the nervous system. This causes blood vessels to constrict, blood pressure to rise rapidly, and can lead to stroke or even death. Immediate steps must be taken to identify and relieve the irritation, and emergency care may be necessary.

Symptoms of an autonomic dysreflexia episode:

• Episodes can occur at any time and may include:
• High blood pressure.
• Severe headache.
• Changes in heart rate (slow pulse).
• Sweating and skin blotches above the spinal cord injury and pale, cold skin below it.
• Blurred vision.
• Nasal congestion.
• Anxiety.
• Stomach discomfort.
• Goosebumps.

Most common triggers of episodes:

• Bladder problems.
• Bowel problems.
• Other sources of discomfort, including any irritation such as wounds, pressure injuries, broken bones, ingrown nails or sunburn.

What to do during an episode:

• Take any prescribed medication from your doctor immediately.
• Sitting upright can help lower blood pressure.
• Monitor blood pressure every 2–5 minutes.
• Identify and relieve the cause. Check the bladder and bowels first.
• If the cause cannot be found or relieved, call emergency services immediately.

Preventing episodes:

Episodes cannot always be prevented, but good self-care is key to reducing their frequency. These steps can help:

• Prevent bladder overfilling or infections, such as urinary tract infections.
• Follow a regular bowel program according to your healthcare provider’s instructions.
• Change positions frequently to relieve pressure on the skin from sitting or lying down.
• Monitor for pressure sores or skin breakdown.
• Take all medications as prescribed.
• Choose shoes carefully.
• Ensure there are no stones or foreign objects in your shoes.
• Avoid excessive sun exposure.
• Check water temperatures to prevent burns.
• Be very careful to prevent falls, especially during transfers.
• Keep a card in your wallet describing episodes, symptoms, and correct treatment.