Complications

Episodes of autonomic dysreflexia (AD) can lead to serious complications affecting the central nervous, cardiovascular, and pulmonary systems. Evidence from clinical studies and case reports shows that AD may result in hemorrhage, cerebral ischemia, seizures, arrhythmias, cardiac arrest, pulmonary edema, and in rare cases, death. Understanding these risks highlights the importance of prompt recognition and effective management of AD in individuals with spinal cord injury.

Discussion

Two studies reported the complications that may result from bouts of AD in individuals with SCI (Wan & Krassioukov 2014; Dolinak & Balraj 2007). In a systematic review of clinical studies, Wan and Krassioukov (2014) found CNS-related, CV, and pulmonary complications following episodes of AD. CNS-related complications were most commonly hemorrhage, but cerebral ischemia/ infarction and seizures or convulsions were also present (Wan & Krassioukov 2014). CV complications included cardiac arrest, arrhythmia, and silent myocardial ischemia; while pulmonary complications identified were pulmonary edemas (Wan & Krassioukov 2014). A case study by Dolinak and Balraj (2007) found that episodes of AD in a 62-year-old male were accompanied by abrupt and intense headaches, abnormal mental status, and resulted in a severe subarachnoid hemorrhage and death, despite treatment with nitroglycerin paste.

Conclusion

There is level 1 evidence (from one systematic review) (Wan & Krassioukov 2014) that cases of AD may result in CNS-related, CV, and pulmonary complications, including those resulting in death.

There is level 5 evidence (from one case report) (Dolinak & Balraj 2007) that AD episodes were accompanied by headaches, followed by abnormal mental status, resulting in a severe subarachnoid hemorrhage and death.