Life-threatening outcomes associated with autonomic dysreflexia: a clinical review.

Context Autonomic dysreflexia (AD) is a life-threatening complication of chronic traumatic spinal cord injury (SCI). Objective To document and provide insight into the life-threatening sequelae associated with AD. Methods A review was conducted to identify literature which documented cases of AD associated with life-threatening outcomes (and death). The search strategy comprised of a keyword search on the PubMed database as well as manual searches of retrieved articles. Outcomes were categorized into three main classes: central nervous system (CNS), cardiovascular (CV), and pulmonary. Results Thirty-two cases of death or life-threatening complications of AD were found. Twenty-three (72%) cases were CNS-related, seven (22%) cases were CV-related, and two (6%) cases were pulmonary-related. In total, seven (22%) deaths were noted as a direct result of complications following an AD attack. Conclusion AD is a well-known consequence of SCI among individuals with high thoracic and cervical injuries. Many of these individuals experience this condition on a daily basis. Medical personnel, care givers, and individuals with SCI should be aware of the importance of timely diagnosis and management of this life-threatening condition, which can result in a variety of significant complications including stroke, seizures, myocardial ischemia, and death.