"The classic syndrome of AD involves excessive peripheral responses that are normally mediated by catecholamines below the level of SCI 7. The mechanism involves a strong stimulus that enters the spinal cord through intact peripheral nerves. The stimulus ascends through the spinothalamic tract and posterior columns below the level of the SCI. This initiates reflex release of catecholamines from the pre-ganglionic neurones in the intermediolateral cell column below and subsequent release of noradrenaline and dopamine resulting in regional vasoconstriction of the GI tract (subdiaphragmatic and splanchnic vasculature) 5. Peripheral vascular resistance increases with associated increase in cardiac output resulting in increased blood pressure. Compensatory reflex bradycardia is seen as the brainstem vasomotor centres attempt to reduce blood pressure."
"Headaches can persist for hours after the rise in blood pressure is treated. This responds to simple analgesia. Regional, spinal and epidural anaesthetic may be used as pre-treatment for episodes that are anticipated with diagnostic or surgical procedures (e.g. repeat radiological imaging, urodynamic studies and catheter change) 4. Epidural anaesthesia is effective in the obstetric setting 12."
"indirect complication: pressure ulcers of the skin due to denervation and arteriovenous shunting leading to ischaemia14"
"The incidence is ~70% (range 48%-91%) of individuals with tetraplegia and high paraplegia 3, with some reporting over 75% of patients with high SCI (above T6) experience AD by one year 8. AD has also been reported after posterior fossa tumours 3. AD generally occurs after the period of spinal shock, commonly between 6-12 months. It is uncommon before 2 months after injury 8."
"Horner's syndrome if injury is at T1: loss of sympathetic input leading to meiosis, ptosis, anhydrosis"
"The classic syndrome of AD involves excessive peripheral responses that are normally mediated by catecholamines below the level of SCI 7. The mechanism involves a strong stimulus that enters the spinal cord through intact peripheral nerves. The stimulus ascends through the spinothalamic tract and posterior columns below the level of the SCI. This initiates reflex release of catecholamines from the pre-ganglionic neurones in the intermediolateral cell column below and subsequent release of noradrenaline and dopamine resulting in regional vasoconstriction of the GI tract (subdiaphragmatic and splanchnic vasculature) 5. Peripheral vascular resistance increases with associated increase in cardiac output resulting in increased blood pressure. Compensatory reflex bradycardia is seen as the brainstem vasomotor centres attempt to reduce blood pressure."
"Other causes such as rectal impaction must be sought 9. However, if a bladder and bowel cause is ruled out, pharmacological management should be initiated. This is done while looking for other less common causes. Rapid onset, short duration anti-hypertensive agents including nitrates (sublingual GTN spray), nifedipine, prazosin, hydralazine and intravenous diazoxide may be used 1."
"Headaches can persist for hours after the rise in blood pressure is treated. This responds to simple analgesia. Regional, spinal and epidural anaesthetic may be used as pre-treatment for episodes that are anticipated with diagnostic or surgical procedures (e.g. repeat radiological imaging, urodynamic studies and catheter change) 4. Epidural anaesthesia is effective in the obstetric setting 12."
Expected headings
"Risk factors"
"Complications"
"It is a distinct entity, is episodic and a rise in blood pressure is a sentinel sign. The intensity of AD can vary from asymptomatic, mild discomfort and headaches to a life-threatening emergency when systolic blood pressure can reach 300 mmHg 9. Untreated episodes of autonomic dysreflexia may have grave consequences, including intracranial haemorrhage, cardiac complications, retinal detachment, cerebral oedema leading to seizures, coma and death 14."
"denervation hypersensitivity of sympathetic spinal, ganglionic or peripheral receptor sites"
"Other causes such as rectal impaction must be sought 9. However, if a bladder and bowel cause is ruled out, pharmacological management should be initiated. This is done while looking for other less common causes. Rapid onset, short duration anti-hypertensive agents including nitrates (sublingual GTN spray), nifedipine, prazosin, hydralazine and intravenous diazoxide may be used 1."
"Headaches can persist for hours after the rise in blood pressure is treated. This responds to simple analgesia. Regional, spinal and epidural anaesthetic may be used as pre-treatment for episodes that are anticipated with diagnostic or surgical procedures (e.g. repeat radiological imaging, urodynamic studies and catheter change) 4. Epidural anaesthesia is effective in the obstetric setting 12."
"Prevention of recurrent episodes of AD includes satisfactory bladder, bowel and skin care. Also vital is patient and carer education (including health professionals who may deal with patients with SCI) regarding presentation, causes, prevention and management of this condition."
"Prevention of recurrent episodes of AD includes satisfactory bladder, bowel and skin care. Also vital is patient and carer education (including health professionals who may deal with patients with SCI) regarding presentation, causes, prevention and management of this condition."
"surgery, e.g. during anaesthetic induction; intrathecal anaesthesia interrupts this autonomic reflex arc"