Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions: Preventing the Highs and Lows

Autonomic dysreflexia (AD) and other autonomic dysfunctions are commonly seen after spinal cord injury
(SCI). However, since SCI is relatively uncommon and the stigmata of AD and autonomic dysfunction are
relatively unique to this population, few clinicians, except those who treat persons with SCI regularly, have
encountered these conditions. As a result, it is thought that AD, which can result in significant morbidity
and mortality when unrecognized or poorly managed, is not uncommonly misdiagnosed in the community.
There are 2 reasons for this: First, the people who are most prone to developing AD typically have low
baseline blood pressures, and a significant increase in blood pressure may not be appreciated by an evaluating
medical provider; second, the most obvious and distressing symptom, a severe headache, is commonly
seen in other conditions. Other autonomic dysfunctions, while perhaps less life-threatening than AD, can
certainly impact the lives of persons with SCI significantly and likely remain undertreated as well.
This clinical practice guideline (CPG), similar to its preceding versions, is anticipated to remain one of
the most important of the Consortium for SCI Medicine.