Autonomic dysreflexia — SCE Neurology MCQ

Correct answer: E — Sit upright, monitor pressure and restore unobstructed urinary catheter drainage

The best answer is “Sit upright, monitor pressure and restore unobstructed urinary catheter drainage”. This is autonomic dysreflexia, a hypertensive emergency after high spinal injury; immediate upright positioning lowers cerebral pressure and removal of the noxious trigger, commonly bladder distension, is the priority while blood pressure is monitored. “Lay the patient flat and defer intervention until spontaneous resolution” is less appropriate because supine positioning can further raise cranial arterial pressure “Give a sedative while leaving the bladder obstruction untreated” is less appropriate because sedation does not remove the afferent trigger driving sympathetic discharge “Perform lumbar puncture for subarachnoid haemorrhage before checking triggers” is less appropriate because the classic lesion level, autonomic features and blocked catheter require immediate treatment before unrelated invasive testing “Encourage oral fluid intake without correcting the drainage problem” is less appropriate because additional fluid can worsen bladder distension when drainage remains obstructed

Reference: Evaluation and management of autonomic dysreflexia and other autonomic dysfunctions. https://pmc.ncbi.nlm.nih.gov/articles/PMC8152175/