Autonomic Dysreflexia

Condition 101

What is the definition of Autonomic Dysreflexia?

Autonomic dysreflexia is an abnormal, overreaction of the involuntary (autonomic) nervous system to stimulation. This reaction may include:

  • Change in heart rate
  • Excessive sweating
  • High blood pressure
  • Muscle spasms
  • Skin color changes (paleness, redness, blue-gray skin color)

What are the alternative names for Autonomic Dysreflexia?

Autonomic hyperreflexia; Spinal cord injury - autonomic dysreflexia; SCI - autonomic dysreflexia

What are the causes for Autonomic Dysreflexia?

The most common cause of autonomic dysreflexia (AD) is spinal cord injury. The nervous system of people with AD over-responds to the types of stimulation that do not bother healthy people.

Other causes include:

  • Guillain-Barré syndrome (disorder in which the body's immune system mistakenly attacks part of the nervous system)
  • Side effects of some medicines
  • Severe head trauma and other brain injuries
  • Subarachnoid hemorrhage (a form of brain bleeding)
  • Use of illegal stimulant drugs such as cocaine and amphetamines

What are the symptoms for Autonomic Dysreflexia?

Symptoms can include any of the following:

  • Anxiety or worry
  • Bladder or bowel problems
  • Blurry vision, widened (dilated) pupils
  • Lightheadedness, dizziness, or fainting
  • Fever
  • Goosebumps, flushed (red) skin above the level of the spinal cord injury
  • Heavy sweating
  • High blood pressure
  • Irregular heartbeat, slow or fast pulse
  • Muscle spasms, especially in the jaw
  • Nasal congestion
  • Throbbing headache

Sometimes there are no symptoms, even with a dangerous rise in blood pressure.

What are the current treatments for Autonomic Dysreflexia?

AD is life threatening, so it is important to quickly find and treat the problem.

A person with symptoms of AD should:

  • Sit up and raise the head
  • Remove tight clothing

Proper treatment depends on the cause. If medicines or illegal drugs are causing the symptoms, those drugs must be stopped. Any illness needs to be treated. For example, the provider will check for a blocked urinary catheter and signs of constipation.

If a slowing of the heart rate is causing AD, drugs called anticholinergics (such as atropine) may be used.

Very high blood pressure needs to be treated quickly but carefully, because the blood pressure can drop suddenly.

A pacemaker may be needed for an unstable heart rhythm.

What is the outlook (prognosis) for Autonomic Dysreflexia?

Outlook depends on the cause.

People with AD due to a medicine usually recover when that medicine is stopped. When AD is caused by other factors, recovery depends on how well the disease can be treated.

What are the possible complications for Autonomic Dysreflexia?

Complications may occur due to side effects of medicines used to treat the condition. Long-term, severe high blood pressure may cause seizures, bleeding in the eyes, stroke, or death.

When should I contact a medical professional for Autonomic Dysreflexia?

Call your provider right away if you have symptoms of AD.

How do I prevent Autonomic Dysreflexia?

To prevent AD, DO NOT take medicines that cause this condition or make it worse.

In people with spinal cord injury, the following may also help prevent AD:

  • DO NOT let the bladder become too full
  • Pain should be controlled
  • Practice proper bowel care to avoid stool impaction
  • Practice proper skin care to avoid bedsores and skin infections
  • Prevent bladder infections


Cheshire WP. Autonomic disorders and their management. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 418.

Cowan H. Autonomic dysreflexia in spinal cord injury. Nurs Times. 2015;111(44):22-24. PMID: 26665385

McDonagh DL, Barden CB. Autonomic dysreflexia. In: Fleisher LA, Rosenbaum SH, eds. Complications in Anesthesia. 3rd ed. Philadelphia, PA: Elsevier; 2018:chap 131.

Latest Research

Latest Advance
  • Condition: Recurrent Urinary Tract Infections (rUTIs)
  • Journal: Current urology reports
  • Treatment Used: Antimicrobial Intravesical Treatment
  • Number of Patients: 285
  • Published —
The purpose of this study was to evaluate the effectiveness of Antimicrobial Intravesical Treatment in the prevention and treatment of recurrent Urinary Tract Infections (rUTIs).
Latest Advance
  • Condition: Sleep-Disordered Breathing (SDB) in Patients with Spinal Cord Injury (SCI)
  • Journal: Spinal cord
  • Treatment Used: Positive Airway Pressure (PAP) Therapy
  • Number of Patients: 91
  • Published —
This study evaluated the effectiveness of bi-level positive airway pressure (PAP) therapy and the patterns of use for sleep-disordered breathing (SDB) in individuals with spinal cord injury (SCI).

Clinical Trials

Clinical Trial
  • Status: Recruiting
  • Study Type: Drug
  • Participants: 5
  • Start Date: June 13, 2019
Pilot Study of Mecamylamine for Autonomic Dysreflexia Prophylaxis
Clinical Trial
  • Status: Recruiting
  • Study Type: Drug
  • Participants: 60
  • Start Date: June 1, 2017
Treatment of Post-SCI Hypotension: A Randomized Controlled Study of Usual Care Versus Anti Hypotension Therapy
Clinical Trial
  • Status: Recruiting
  • Study Type: Other
  • Participants: 110
  • Start Date: December 2016
A Longitudinal Examination of Aging With a Spinal Cord Injury: Cardiovascular, Cerebrovascular and Cognitive Consequences
Clinical Trial
  • Status: Recruiting
  • Study Type: Drug
  • Participants: 50
  • Start Date: December 2016
The Effects of Normalizing Blood Pressure on Cerebral Blood Flow in Hypotensive Individuals With Spinal Cord Injury