Neurological Disorders Q 38

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A nurse assesses a client who has episodes of autonomic dysreflexia. Which of the following conditions can cause autonomic dysreflexia?

  

     A. Headache

     B. Lumbar spinal cord injury

     C. Neurogenic shock

     D. Noxious stimuli

    

    

Correct Answer: D. Noxious stimuli

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Noxious stimuli, such as a full bladder, fecal impaction, or a decubitus ulcer, may cause autonomic dysreflexia. Dysregulation of the autonomic nervous system leads to an uncoordinated autonomic response that may result in a potentially life-threatening hypertensive episode when there is a noxious stimulus below the level of the spinal cord injury. In about 85% of cases, this stimulus is from a urological source such as a UTI, a distended bladder, or a clogged Foley catheter.

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Option A: A headache is a symptom of autonomic dysreflexia, not a cause. Autonomic dysreflexia should be strongly suspected in any spinal cord injured patient with a lesion above T6 who complains of a headache. A blood pressure reading should be taken immediately, and corrective treatment starts if the patient’s blood pressure is significantly elevated as most spinal cord injured patients have low blood pressure.

Option B: Autonomic dysreflexia is most commonly seen with injuries at T10 or above. Spinal cord injuries below T10 rarely result in autonomic dysreflexia because the splanchnic innervation remains intact and allows for compensatory parasympathetic dilation of the splanchnic vascular bed. The etiology is a spinal cord injury, usually above the T6 level. It is unlikely to occur if the level is below T10. The higher the injury level, the greater the severity of the cardiovascular dysfunction.

Option C: Neurogenic shock isn’t a cause of dysreflexia. The severity and frequency of autonomic dysreflexia episodes are also associated with the completeness of the spinal cord injury. Patients usually develop autonomic dysreflexia one month to one year after their injury. However, it has also been described in the first days or weeks after the original trauma. Objectively, an episode is defined as an increase in systolic blood pressure of 25 mm Hg.

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