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Autonomic Dysreflexia — SCE Neurology MCQ

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HardNeurorehabilitationAutonomic DysreflexiaSCE Neurology

A person with a high spinal-cord injury develops hypertension, reflex bradycardia, flushing above the lesion and sweating after bladder distension. Which physiological mechanism explains this episode?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Unrestrained sympathetic discharge below the lesion with baroreflex vagal slowing

The best answer is “Unrestrained sympathetic discharge below the lesion with baroreflex vagal slowing”. A noxious stimulus below a high cord lesion triggers unopposed sympathetic vasoconstriction; intact baroreceptors respond to hypertension with vagal bradycardia, but descending inhibition cannot cross the lesion. The alternatives “Loss of sympathetic tone below the lesion causing distributive hypotension”, “A primary vagal discharge causing hypertension and distal vasoconstriction”, “Raised intracranial pressure producing an isolated Cushing response”, “Adrenal catecholamine release independent of the spinal lesion” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE CG150 headache recommendations: https://www.nice.org.uk/guidance/cg150/chapter/Recommendations