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Autonomic Dysreflexia — SCE Neurology MCQ

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ModerateNeurorehabilitationAutonomic DysreflexiaSCE Neurology

A 45-year-old man with a C5 complete spinal cord injury 6 months ago develops sudden severe headache, hypertension (220/130 mmHg), bradycardia, flushing and sweating above the level of injury. He has a distended bladder. What is the diagnosis and what is the priority management?

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Correct answer: C — Autonomic dysreflexia — sit the patient upright and identify and remove the trigger (catheterise the bladder)

Autonomic dysreflexia (AD) occurs in spinal cord injuries at T6 or above due to uninhibited sympathetic discharge triggered by noxious stimuli below the level of injury (most commonly bladder distension or bowel impaction). It is a medical emergency. Management: sit upright (reduces BP via orthostatic pooling), immediately identify and remove the trigger (catheterise the bladder, check for faecal impaction, tight clothing). If hypertension persists after trigger removal, sublingual nifedipine or GTN may be used. A: IV labetalol is inappropriate without addressing the trigger. C: Phaeochromocytoma is not consistent with SCI context. D: PRES has different clinical features. E: SAH is less likely in this context.

Reference: NICE NG62 Spinal Cord Injury (2016)