Spinal Cord Injury and Autonomic Dysreflexia: A Case Report on an Overlooked Complication of Spinal Cord Injury

Autonomic dysreflexia (AD) is a life-threatening condition that affects patients with spinal cord injuries (SCI) at the sixth thoracic vertebrae (T6) and above due to a noxious stimulus below the level of spinal cord injury. This is a case report of a 48-year-old man with a history of paraplegia T1 (American Spinal Injury Association Impairment Scale - ASIA A) spinal cord injury due to a road traffic accident 16 years ago who presented with recurrent episodes of hypertension, sweating, bradycardia, and hypothermia. Previous hospitalizations suggested that his symptoms were caused by sepsis from a urinary tract infection; however, further assessment revealed that his symptoms were consistent with untreated and undiagnosed autonomic dysreflexia. This case report provides an overview of AD, including its distinctive presentation, etiology, pathophysiology, and management. Autonomic dysreflexia can be a life-threatening condition associated with spinal cord injury patients at the T6 level and above due to various noxious stimuli below the neurological level of injury. Bladder distension appears to be the trigger in most of the cases reported. AD can be easily missed by medical staff unfamiliar with this condition. Patient and healthcare provider education and a thorough evaluation are essential for diagnosis and management.