Life-threatening outcomes associated with autonomic dysreflexia: a clinical review

Abstract

Context Autonomic dysreflexia (AD) is a life-threatening complication of chronic traumatic spinal cord injury (SCI). Objective To document and provide insight into the life-threatening sequelae associated with AD. Methods A review was conducted to identify literature which documented cases of AD associated with life-threatening outcomes (and death). The search strategy comprised of a keyword search on the PubMed database as well as manual searches of retrieved articles. Outcomes were categorized into three main classes: central nervous system (CNS), cardiovascular (CV), and pulmonary. Results Thirty-two cases of death or life-threatening complications of AD were found. Twenty-three (72%) cases were CNS-related, seven (22%) cases were CV-related, and two (6%) cases were pulmonary-related. In total, seven (22%) deaths were noted as a direct result of complications following an AD attack. Conclusion AD is a well-known consequence of SCI among individuals with high thoracic and cervical injuries. Many of these individuals experience this condition on a daily basis. Medical personnel, care givers, and individuals with SCI should be aware of the importance of timely diagnosis and management of this life-threatening condition, which can result in a variety of significant complications including stroke, seizures, myocardial ischemia, and death.

Keywords: Autonomic dysreflexia; Hemorrhage; Ischemia; Seizures; Spinal cord injuries.

Figure 1

A case of AD accompanied by documented arrhythmia in a man with cervical incomplete SCI (C3 AIS C – American Spinal Injury Association Impairment Scale) during a vibrostimulation procedure to facilitate sperm retrieval. Continuous BP and ECG were recorded during the procedure. A representative recording of BP (top image) and a 20-second ECG recording during the episode of AD (bottom image) are presented. Despite the fact that 5 mg of nifedipine was given ∼20 minutes before initiation of vibrostimulation, the individual developed a significant elevation in BP (up to 200 mmHg) and a prolonged period of arrhythmia with groups of premature ventricular contractions.

Figure 2

Box plot showing higher mean SBP in the group of patients who resulted in death as the final outcome. However, subsequent analysis did not show statistical significance (P = 0.0584).