Autonomic Dysreflexia

A syndrome associated with damage to the spinal cord above the mid thoracic level (see SPINAL CORD INJURIES) characterized by a marked increase in the sympathetic response to minor stimuli such as bladder or rectal distention. Manifestations include HYPERTENSION; TACHYCARDIA (or reflex bradycardia); FEVER; FLUSHING; and HYPERHIDROSIS. Extreme hypertension may be associated with a STROKE. (From Adams et al., Principles of Neurology, 6th ed, pp538 and 1232; J Spinal Cord Med 1997;20(3):355-60)

Also Known As:

Networked: 200 relevant articles (19 outcomes, 14 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Spinal Cord Injuries (Spinal Cord Injury)
2.	Hypertension (High Blood Pressure)
3.	Spasm (Spasms)
4.	Shock
5.	Seizures (Seizure)

Experts

1.	Vaidyanathan, Subramanian: 10 articles (01/2015 - 11/2002)
2.	Oo, Tun: 9 articles (01/2015 - 11/2002)
3.	Singh, Gurpreet: 8 articles (01/2015 - 11/2002)
4.	Soni, Bakul M: 7 articles (01/2015 - 11/2002)
5.	Hughes, Peter L: 7 articles (01/2015 - 11/2002)
6.	Krassioukov, Andrei V: 5 articles (04/2015 - 07/2005)
7.	Marsh, Daniel R: 4 articles (10/2010 - 12/2002)
8.	Elliott, Stacy L: 3 articles (04/2015 - 07/2005)
9.	Soni, Bakul: 3 articles (01/2012 - 01/2011)
10.	Rabchevsky, Alexander G: 3 articles (01/2012 - 01/2006)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Autonomic Dysreflexia:

1.	Nifedipine (Adalat)FDA LinkGeneric 08/01/1988 - "Ten milligrams of nifedipine given sublingually ten to 15 minutes before electroejaculation attempts helped to moderate autonomic hyperreflexia and the associated blood pressure elevations. " 01/01/2011 - "(1) Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5-10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. " 10/01/2008 - "Episodes of autonomic dysreflexia were aggressively managed using pre-emptive epidural anaesthesia and sublingual nifedipine. " 01/01/2008 - "Each acute episode of dysreflexia was controlled by nifedipine given sublingually in doses varying from 5 to 20 mg. No inciting cause for autonomic dysreflexia could be found other than chronic aortic dissection. " 09/01/2002 - "Antihypertensive therapy, nifedipine, and autonomic dysreflexia."
2.	Prazosin (Minipress)FDA LinkGeneric 04/01/1992 - "Compared to baseline measurements, patients allocated to prazosin therapy were found to have fewer severe episodes of autonomic dysreflexia and during these episodes to have significant reductions in average rise in systolic and diastolic blood pressure, symptom duration and requirement for acute antihypertensive medication. " 03/15/2015 - "The present study examined the effect of a short-acting selective α1 antagonist (prazosin) on autonomic dysreflexia severity using a randomized placebo trial during medically supervised penile vibrostimulation in six males with cervical spinal cord injury. " 04/01/1992 - "A study of the alpha-1 adrenoceptor blocker prazosin in the prophylactic management of autonomic dysreflexia in high spinal cord injury patients." 04/01/2015 - "Prazosin: a potential new management tool for iatrogenic autonomic dysreflexia in individuals with spinal cord injury?" 04/01/1992 - "The severity of headache during individual autonomic dysreflexia episodes was also diminished with prazosin therapy. "
3.	Doxazosin (Cardura)FDA LinkGeneric 01/01/2011 - "The alpha-adrenoceptor blocking drug doxazosin was used to reduce the severity of autonomic dysreflexia. " 01/01/2008 - "This patient's medication was then changed to doxazosin 8 mg, twice a day, and sustained-release nifedipine 10 mg, twice a day, which helped to prevent recurrent autonomic dysreflexia. " 01/01/2011 - "Intermittent catheterisations along with an alpha-adrenoceptor blocking drug (doxazosin) and an antimuscarinic drug (propiverine hydrochloride) helped this individual to control autonomic dysreflexia, triggered by bladder spasms during the night."
4.	Terazosin (Hytrin)FDA LinkGeneric 01/01/1994 - "Terazosin appears to be effective in preventing serious harm from autonomic dysreflexia without erectile function impairment. " 11/01/1998 - "These neurophysiological changes possibly contribute to the development of autonomic dysreflexia, a condition of sympathetic hyper-excitability that develops after cervical, or upper dorsal cord injury with resultant paroxysmal rise in arterial pressure, and provide the scientific basis for the use of terazosin, a once-a-day, selective alpha-one adrenergic blocking drug. " 01/01/1994 - "Terazosin was evaluated in 21 normotensive spinal cord injured patients with autonomic dysreflexia. " 01/01/1994 - "Prospective evaluation of terazosin for the treatment of autonomic dysreflexia." 11/01/1998 - "An open, prospective study of the efficacy of terazosin in controlling recurrent autonomic dysreflexia in traumatic tetraplegic/paraplegic patients manifesting clinical features of dysreflexia in the absence of an acute precipitating cause such as a blocked catheter. "
5.	Lidocaine (Xylocaine)FDA LinkGeneric 08/01/2005 - "The purpose of this study was to determine whether lidocaine anal sphincter block would be effective in limiting anorectal procedure-associated autonomic dysreflexia. " 08/01/2005 - "However, a previous randomized, double-blind, placebo-controlled trial showed that topical lidocaine in the rectum does not blunt the autonomic dysreflexia response to anorectal procedures. " 03/01/2002 - "This study tested whether topical lidocaine would prevent or limit anorectal procedure-associated autonomic dysreflexia. " 08/01/2005 - "Lidocaine anal block significantly limits the autonomic dysreflexia response in susceptible patients undergoing anorectal procedures." 03/01/2002 - "Topical lidocaine did not significantly limit or prevent autonomic dysreflexia in susceptible patients. "
6.	Calcium Channels (Calcium Channel)IBA 01/01/1995 - "The object of this study was to develop a spinal cord injury (SCI) rat model for autonomic dysreflexia (AD), assessing the effect of alpha-adrenergic and calcium channel blockade and to determine the relationship of detrusor-external sphincter dyssynergia (DESD) to the development of AD. " 02/01/1985 - "A comparison of the efficacy of an alpha-I-adrenergic blocker in the slow calcium channel blocker in the control of autonomic dysreflexia." 03/15/2015 - "Nifedipine, a selective calcium channel blocker, is the most commonly prescribed pharmaceutical for a priori management of autonomic dysreflexia secondary to ejaculation or other causes; however, it is limited because of its potential exacerbation of low resting pressure, which also affects this population. " 03/01/1992 - "Nifedipine, a calcium channel blocker, has been used to treat autonomic hyperreflexia in quadriplegics undergoing invasive urological procedures. " 09/01/1990 - "Ten spinal-cord-injured males who exhibited autonomic dysreflexia during electroejaculation were given sublingual calcium channel blocker nifedipine pretreatment to prevent this complication. "
7.	Norepinephrine (Noradrenaline)FDA LinkGeneric 02/01/1988 - "Ratio of residual urine as a parameter of voiding efficiency and blood pressure and plasma noradrenaline level during voiding as parameters of the significance of autonomic dysreflexia were evaluated before and after TUR-sph, and all these parameters had significantly improved after TUR-sph. " 04/01/1998 - "To determine if norepinephrine (NE) levels increased during autonomic dysreflexia (AD) hypertension in spinal cord injured rats. " 05/01/1996 - "These findings suggest that there is no concern over inadequate physiological androgen response to an exercise stimulus in SCI. The data do not support the previous findings that elevated levels of norepinephrine in autonomic dysreflexia suppress testosterone response to exercise." 04/01/1995 - "Autonomic dysreflexia is further accentuated by the absence of gamma amino benzoic acid (GABA), norepinephrine (NE) and 5-hydroxytryptamine (5-HT) below the lesion. " 06/01/1997 - "To document the pathology and study the etiology of autonomic dysreflexia to further investigate its mechanism, this paper presents some clinical data on the determination of vasoactive substances such as norepinephrine (NE), epinephrine (E), renin (R), angiotensin II (AII) and atrial natriuretic polypeptide (ANP) before and during bladder percussion in 30 patients with a thoracolumbar or cervical spine and spinal cord injury. "
8.	Adrenergic Receptors (Adrenergic Receptor)IBA 10/01/1995 - "A controlled study of acute pharmacological intervention was designed to determine whether decreased sympathetic nerve activity in tetraplegic patients results in increased responsiveness of alpha-adrenoceptors which might contribute to vascular hyperreactivity and the clinical scenario of autonomic dysreflexia. " 04/01/1995 - "These results suggest that autonomic dysreflexia is mediated exclusively by adrenergic receptors in the spinal rat. " 10/01/1995 - "Hypersensitivity of vascular alpha-adrenoceptors may contribute to autonomic dysreflexia in patients with high spinal cord injury." 04/01/1992 - "It is concluded that prazosin is superior to placebo in the prophylactic management of autonomic dysreflexia and that these findings are consistent with suggestions that alpha-1 adrenoceptors play an important role in the pathogenesis of this syndrome." 04/01/1995 - "Contribution of alpha- and beta- adrenoceptors and neuropeptide-Y to autonomic dysreflexia."
9.	BaclofenFDA LinkGeneric 01/01/1990 - "Intrathecal baclofen was also effective against autonomic hyperreflexia, i.e. " 10/01/2004 - "To report insidious development of autonomic dysreflexia and hydronephrosis due to dyssynergic voiding following discontinuation of intrathecal baclofen therapy. " 10/01/2004 - "Delayed complications of discontinuation of intrathecal baclofen therapy: resurgence of dyssynergic voiding, which triggered off autonomic dysreflexia and hydronephrosis." 01/01/2010 - "Baclofen withdrawal syndrome is a rare and potentially life-threatening condition manifesting with autonomic dysreflexia, high fevers, spasticity, seizures, and multiorgan failure. " 10/01/2008 - "Intrathecal baclofen withdrawal should be differentiated with autonomic dysreflexia, malignant hyperthermia, neuroleptic malignant syndrome, and serotonin syndrome. "
10.	Capsaicin (Zostrix)FDA Link 06/01/1998 - "EMDA virtually eliminated the hyperreflexic contractions of the bladder occurring during capsaicin instillations, thus reducing the risk of urethral leakage, and prevented autonomic dysreflexia that had previously occurred in 1 patient. " 05/01/2003 - "To determine whether capsaicin-sensitive nerves in the bladder form the afferent limb involved in autonomic dysreflexia (AD) in patients with spinal cord injury (SCI). " 05/01/2003 - "The role of capsaicin-sensitive afferents in autonomic dysreflexia in patients with spinal cord injury." 04/01/2002 - "Autonomic dysreflexia, limb spasms, suprapubic discomfort and hematuria developed in most patients who received capsaicin but in none who received resiniferatoxin. "

Therapies and Procedures

1.	Catheters 01/01/2014 - "Missed signs of autonomic dysreflexia in a tetraplegic patient after incorrect placement of urethral Foley catheter: a case report." 11/01/2010 - "In August, 2009, the catheter obstruction induced autonomic dysreflexia (AD). " 01/01/2008 - "The catheter was removed from the first patient because he developed autonomic dysreflexia during implantation. " 03/01/1990 - "All patients are free from risk of autonomic dysreflexia and catheter trouble. " 06/01/2013 - "Two factors contributed to this serious complication: first, autonomic dysreflexia triggered by minor malfunction and/or irritation from the cystostomy catheter; and second, the medical staff lacked sufficient experience in and knowledge about the management of autonomic dysreflexia.It"
2.	Stents 09/01/2012 - "Severe autonomic dysreflexia was present in 17 cases before stent placement and in 7 after stents were placed (P=0.003). " 02/01/2011 - "Twenty-two men with elevated (> 100 mL) residual urine and/or voiding difficulties/autonomic dysreflexia were treated with a Memokath stent. " 05/01/1999 - "Hydronephrosis and autonomic dysreflexia improved or stabilized in most patients with functioning stents. " 11/01/2010 - "We did not encounter any problem with stent migration, urethral erosion, erectile dysfunction or autonomic dysreflexia. " 01/01/2003 - "There were no problems with stent migration, urethral erosion, erectile dysfunction or autonomic dysreflexia. "
3.	Lithotripsy (Extracorporeal Shockwave Lithotripsy) 01/01/2012 - "These cases show that tetraplegic patients are likely to develop autonomic dysreflexia during cystoscopy and vesical lithotripsy, performed without anaesthesia. " 01/01/2012 - "Some tetraplegic patients may wish to undergo urological procedures without anaesthesia, but these patients can develop autonomic dysreflexia if cystoscopy and vesical lithotripsy are performed without anaesthesia. " 09/01/1989 - "Autonomic hyperreflexia during extracorporeal shock-wave lithotripsy (ESWL) in quadriplegic patients." 06/01/1989 - "Autonomic hyperreflexia in spinal cord injured patients during extracorporeal shock wave lithotripsy." 02/01/1995 - "[Extracorporeal shock wave lithotripsy on patients with spinal cord injury with special reference to autonomic hyperreflexia]."
4.	Epidural Analgesia 02/01/1990 - "Continuous epidural analgesia may be helpful for pregnant women who are susceptible to autonomic hyperreflexia." 03/01/2003 - "In early labour epidural analgesia was maintained and the vaginal delivery was successful without associated fluctuation of blood pressure or other signs of autonomic hyperreflexia. " 05/13/1996 - "In early labour epidural analgesia was established and the vaginal delivery was successful without associated fluctuation of the blood pressure or other signs of autonomic hyperreflexia." 02/01/1990 - "Epidural analgesia and autonomic hyperreflexia: a case report."
5.	Surgical Instruments (Clip) 01/01/2006 - "We found that the incidence of autonomic dysreflexia is greatly reduced, compared to spinal cord-transected wild-type mice, in Wld s mice after both injury paradigms and in 129Sv and C57BL/6 that have undergone the clip-compression injury. " 08/01/2005 - "We compared the effects of a 2-day MP treatment and/or the anti-CD11d mAb on autonomic dysreflexia, elicited by colon distension, after clip-compression SCI at the 4th thoracic segment (T4) in rats. " 10/01/2001 - "This clinically relevant clip compression cord injury model, studied more frequently for locomotor function, is excellent for investigating mechanisms for the development of autonomic dysreflexia and strategies for its prevention." 10/01/2001 - "These findings suggest that after severe but not mild clip compression injury of the spinal cord, sprouting of the afferent component of the spinal reflex are contributes to the development of autonomic dysreflexia. " 10/01/2001 - "Autonomic dysreflexia was induced by colon distension in the conscious rats 2 weeks after severe (50-g) clip compression injury of the spinal cord at the 4th thoracic segment. "