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Autonomic dysreflexia: Autonomic dysreflexia (AD) is a condition that can occur in anyone who has a spinal cord injury at or above the T6 level. It is related to disconnections between the body below the injury and the control mechanisms for blood pressure and heart function. It causes the blood pressure to rise to potentially dangerous levels.
AD can be caused by a number of things. The most common causes are a full bladder, bladder infection, severe constipation, or pressure sores. Anything that would normally cause pain or discomfort below the level of the spinal cord injury can trigger dysreflexia. AD can occur during medical tests or procedures and need to be watched for.
The symptoms that occur with AD are directly related to the types of responses that happen in the sympathetic and parasympathetic nervous systems. Symptoms such as a pounding headache, spots before the eyes, or blurred vision are thee direct result of the high blood pressure that occurs when blood vessels below the injury constrict. The body responds by dilating blood vessels above the injury, causing flushing of the skin, sweating, and occasionally goosebumps. Some patients describe nasal stuffiness and will feel very anxious. Uncontrolled AD can cause a stroke if not treated.
The treatment for AD involves removing the reason for the stimulation. One of the first things a patient can do is to sit up. This naturally decreases blood prsessure. If there is a catheter in place, it should be checked to be certain that there is not a kink in the tubing. If there is not a catheter in place, the patient should be catheterized. The bowels should be checked to be ceratin there is no stool in the rectum. If the symptoms are caused by skin breakdown, the patient should get to an emergency department as soon as possible.
The primary risk of AD is stroke. It is a potentially life-threatening condition. If AD is left untreated, the body's attempt to control blood pressure will severely decrease the heart rate. This, combined with uncontrolled high blood pressure, can be fatal. For this reason, it is very important to treat this condition as soon as possible. The most important thing patients can do to prevent AD from occurring is to take good care of themselves. Patients should monitor bladder output (also see bladder care and management) and should maintain a regular bowel program which fully empties the bowels. They should also do regular skin checks to prevent pressure sores from occurring.
 The Paralyzed Veterans of America has put together a more detailed, in depth guide to AD that you can download here and view in your browser.
(The guide requires Adobe Acrobat 3.0 or later if you have trouble viewing the guide download the latest version here)
Deep vein thrombosis: (DVT) or pulmonary embolism is a potentially severe complication of spinal cord injury. As mentioned above, there are changes in the normal neurologic control of the blood vessels that can result in stasis or "sludging". Deep vein thrombosis in the lower leg is almost universal during the early phases of recovery and rehabilitation. Thromboses in the thigh, however, are a great concern, as they are at risk for becoming dislodged and passing through the vascular tree to the lungs. A major obstruction of the arteries leading to the lung can potentially be fatal. Therapeutic measures to reduce or eliminate the risk for deep vein thrombosis include Ace wrapping of the legs and the use of pneumatic compression stockings. Medications administered subcutaneously, such as heparin, are useful in reducing blood viscosity and improving flow. In the event that a thrombosis develops, treatment is begun with intravenous heparin. Once adequate anticoagulation is provided, the patient is switched to or medication, called Coumadin
Cardiovascular disease: Cardiovascular disease is a major long-term risk of spinal cord injury. SCI individuals live in general rather sedentary lives and are at higher risk for cardiovascular disease than the able-bodied population. Therefore, careful assessment of cardiovascular function and the encouragement of exercise programs are appropriate and necessary long-term aspects of spinal cord injury management and care. The prescription of upper extremity exercise programs in spinal cord-injured individuals are similar to those used in other populations with the exception of the use of adaptive equipment such as racing wheelchairs or monoskis.
Syringomyelia- A post-traumatic enlargement of the central canal of the spinal cord is termed syringomyelia. It occurs in approximately 1-3% of all spinal cord-injured individuals. The primary risk of syringomyelia is a loss of function above the level of the original spinal cord injury. For example, in a patient with a thoracic-level spinal cord injury may complain to his or her physician of numbness and weakness involving the extremities. The condition will progress with time and needs to be treated aggressively through surgical drainage. Often patients with early evidence of a syrinx will be followed to evaluate the progression of the condition. Significant syringomyelia is treated with surgical decompression and the placement of a drainage tube into the spinal cord.
Neuropathic/Spinal Cord Pain- Neuropathic (nerve-generated) pain is a significant problem in some spinal cord-injured patients. Varying types of pain are described in spinal cord injury. Damage to the spine and soft tissues surrounding the spine can cause aching at the left of the injury. Nerve root pain is described as sharp or may be described as having an electric shock-type quality. Occasionally SCI patients will describe phantom limb pain or pain that radiates from the level of the lesion in a specific pattern that is related to injury or dysfunction at the nerve root or spinal cord level. Various medications and nerve block procedures have been described and are of some use in the treatment of neuropathic pain following spinal cord injury.
Respiratory Dysfunction- Respiratory complications and infection predominate as post-SCI complications. When the injury involves the upper thorax, the normal breathing pattern is permanently altered. The diaphragm does most of the work in quiet breathing. The chest wall muscles (intercostals) are used primarily for deep breathing or coughing. The abdominal muscles also participate in coughing. When the intercostal and abdominal muscles are paralyzed, the entire load is taken by the diaphragm. This results in poor coughing and a high risk of pneumonia. Pneumonia is one of the most common complications of acute spinal cord injury. Preventive measures are very important to reduce the risk of pneumonia. These include: percussion and drainage using gravity to assist; assisted coughing (also termed "quad" coughing); abdominal binders (to increase the resistance against which the diaphragm works); and early mobilization (i.e.; getting the patient out of bed as soon as possible) Also see "Smoking and SCI"
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