Managing Life After a Spinal Cord Injury: Understanding Autonomic Dysreflexia

After a spinal cord injury, the path to recovery is typically focused on regaining mobility and adjusting to a new reality. However, a serious and potentially life-threatening condition known as Autonomic Dysreflexia (AD) may emerge. It is a sudden, uncontrolled spike in blood pressure caused by a painful or irritating stimulus below the level of your injury—a stimulus your body no longer properly regulates.

Up to 90% of individuals with spinal cord injuries at or above the T6 level (roughly the bottom of the shoulder blades) are susceptible to these episodes. This condition increases the risk of stroke by 300% to 400%.

While your doctors manage the initial injury, AD is a long-term complication that requires constant vigilance and understanding. If your spinal cord injury was the result of someone else’s negligence (such as a car accident, a workplace incident, or a fall), the significant costs associated with managing Autonomic Dysreflexia are a component of the damages you may recover.

If you have a question about how a complication like Autonomic Dysreflexia after spinal cord injuries affects your case, call us for a no-cost discussion at (201) 585-9111.

Key Takeaways for Autonomic Dysreflexia and Spinal Cord Injury Claims

1. AD is a serious, life-threatening complication for those with high-level spinal cord injuries. It is a sudden spike in blood pressure that significantly increases stroke risk and requires immediate identification of its cause.
2. The costs of managing AD must be included in your personal injury claim. This includes future medical care, emergency interventions, and specialized supplies needed to prevent and treat episodes.
3. Awareness of AD is low, even among some medical professionals, which creates risks. Mismanagement of an episode by a healthcare provider may lead to additional harm and a potential medical malpractice claim.

What Is Autonomic Dysreflexia? A Simple Explanation of a Complicated Problem

Living with a spinal cord injury introduces a new set of rules for how your body operates. One of the most serious of these new rules involves a condition that turns a simple bodily irritation into a medical emergency.

The Body’s Misguided Alarm System

Think of your autonomic nervous system as your body’s automatic control center, managing functions like blood pressure, heart rate, and digestion without you having to think about them. A spinal cord injury acts like a roadblock, disrupting the communication lines between your brain and the parts of your body below the injury site.

When something irritating happens below this roadblock (like a full bladder or a tight sock) a signal of discomfort travels up the spinal cord but gets blocked. Your body still reacts to what it perceives as a “threat” by tightening blood vessels, which causes a rapid and dangerous increase in blood pressure. Because the warning signal is blocked from reaching the brain, your brain cannot send the “calm down” message to the lower part of your body.

Common Triggers You Need to Know

The key to managing an episode of Autonomic Dysreflexia is to quickly find and remove the trigger. Since the sensation of pain may be gone, you and your caregivers must become detectives, searching for the source of the body’s alarm.

• Bladder Issues: A distended (overly full) bladder is the most common culprit, responsible for up to 85% of all AD cases. This is caused by a kinked or clogged catheter, a full collection bag, or a urinary tract infection (UTI).
• Bowel Impaction: The second most frequent cause is a full or impacted bowel, which accounts for a significant number of episodes.
• Skin Irritation: Simple sources include restrictive clothing, pressure sores, an ingrown toenail, a burn, or even a shoelace tied too tightly.
• Other Causes: Other potential triggers include fractures, medical procedures, menstruation, or sexual intercourse.

Why Autonomic Dysreflexia Is a Medical Emergency: Recognizing the Warning Signs

It is easy to underestimate the danger of Autonomic Dysreflexia if you are unfamiliar with it. However, this is a serious medical event. Some reports indicate a mortality rate directly linked to AD complications as high as 22% in documented cases of severe outcomes.

It’s More Than Just a Headache

The primary and most-reported symptom is a sudden, throbbing headache. If you have a high-level spinal cord injury and experience a severe headache that appears out of nowhere, your blood pressure should be checked immediately. 

Symptoms Above the Level of Injury

During an episode, your body essentially divides into two different zones. Above the level of your spinal cord injury, you might experience:

• High blood pressure (a systolic pressure rising 20-40 mmHg or more above your baseline is a key indicator).
• Pounding headache.
• Flushed face or red blotches on the skin.
• Profuse sweating.
• Nasal congestion.
• A sense of anxiety or apprehension.

Symptoms Below the Level of Injury

In contrast, the area below your injury may show opposite signs due to the mixed-up nerve signals:

• Pale, cool, clammy skin.
• Goosebumps.

The Threat of “Silent” Autonomic Dysreflexia

Not every episode of AD announces itself with a pounding headache. In many cases, blood pressure spikes without any obvious symptoms at all. This is also called “silent” Autonomic Dysreflexia. Research suggests that silent AD occurs in a significant number of patients, with some studies showing a prevalence between 42.9% and 63.6%.

This makes regular blood pressure monitoring and a deep awareness of potential triggers even more important for managing your health. Episodes happen with startling frequency; some individuals may experience them up to 40 times a day, often without knowing it. If your spinal cord injury resulted from an accident, understanding these less obvious but equally dangerous aspects of your condition is part of building a complete picture of your long-term medical needs.

Does My Injury Put Me at Risk?

Not every person with a spinal cord injury will develop Autonomic Dysreflexia. The risk is closely tied to the location and severity of the damage to your spinal cord.

The “T6” Rule of Thumb

Autonomic Dysreflexia primarily affects individuals with spinal cord injuries at or above the sixth thoracic vertebra (T6). This is because the T6 level is a key junction for the nerves that help control the body’s cardiovascular response, including the regulation of blood pressure. Injuries at or above this point are more likely to disrupt the communication between the brain and these regulatory nerves.

The prevalence among this specific group is high. Studies indicate that between 48% and 90% of individuals with an injury at T6 or above will experience AD at some point.

“Complete” vs. “Incomplete” Injuries

The severity of your injury also plays a significant role. In simple terms, a “complete” injury means there is a total loss of sensation and motor function below the injury level. An “incomplete” injury means some signals still get through the damaged area.

Autonomic Dysreflexia is far more common in those with complete injuries. Around 91% of individuals with complete injuries are likely to experience it, compared to about 27% of those with incomplete injuries (according to research cited above). However, even if your injury is classified as incomplete, the risk is not zero. It is a possibility that you, your family, and your entire care team should be prepared for. 

How Does Autonomic Dysreflexia Affect a Personal Injury Claim?

When a spinal cord injury is caused by someone else’s negligence, a personal injury claim is intended to provide compensation for all the harm that results—not just the initial hospitalization and visible injuries. Autonomic Dysreflexia after a spinal cord injury is a direct, lifelong, and costly consequence that must be factored into any fair settlement or verdict.

Calculating Future Damages

In a personal injury claim, compensation is divided into different categories of “damages.” For a condition like AD, your claim must account for future economic damages, which are the tangible, out-of-pocket costs you will face. We work to project these costs over your lifetime. 

These include:

• Specialized Medical Care: The need for ongoing consultations with neurologists, urologists, and cardiologists who understand AD.
• Emergency Medical Interventions: The potential for ambulance rides and emergency room visits if an episode cannot be managed safely at home.
• Medications: Prescription drugs to help manage blood pressure during a crisis.
• Adaptive Equipment & Supplies: The recurring cost of specialized catheters, blood pressure monitors, and other supplies needed to prevent triggers.
• In-Home Care: The cost of assistance from a caregiver who is properly trained to recognize the signs of AD and respond immediately.

Quantifying the Impact on Your Life (Non-Economic Damages)

Living with the constant threat of an AD episode rewrites every aspect of life. This is what the law refers to as “pain and suffering” or “loss of enjoyment of life.” These are non-economic damages, and they are just as real as any medical bill.

This includes the persistent anxiety that a headache could be the start of a stroke, the fear of a catastrophic event, and the daily burden of managing triggers to stay safe. 

Our role is to build a case that clearly communicates the full human cost of this condition to the insurance company and, if necessary, a jury. We work with medical and life-care planning professionals to ensure this significant impact is not overlooked when calculating fair compensation.

When Medical Professionals Don’t Recognize the Signs

You might assume that all doctors, nurses, and first responders are familiar with Autonomic Dysreflexia. Unfortunately, that is not always the case, which could lead to frightening and dangerous situations.

A Frightening Lack of Awareness

Studies have shown that many healthcare workers—including those in emergency rooms who are typically the first to witness an episode—are unable to recognize or properly manage it. In one survey of physicians, 40% of the participants could not answer any questions on a questionnaire about the condition. In another study, some patients reported that their AD symptoms were not recognized by the healthcare workers treating them.

How This Complicates Your Situation

If your original spinal cord injury was caused by an accident, and then your subsequent AD is mismanaged in a hospital or clinic, it leads to additional, preventable harm. This creates a complicated legal situation.

For example, a doctor performing a routine procedure might inadvertently cause an AD episode and fail to respond correctly, leading to a stroke. In such a scenario, you might have a personal injury claim against the person who caused the initial accident and a separate medical malpractice claim against the healthcare provider who failed to meet the standard of care.

At Maggiano, DiGirolamo & Lizzi, P.C., we have experience investigating difficult cases where multiple parties may bear responsibility. Our firm will meticulously review medical records to determine if the care you received met the accepted standard. We are prepared to hold all responsible parties accountable for the harm they have caused.

Frequently Asked Questions About Autonomic Dysreflexia

My spinal cord injury happened a year ago. Is it possible to still develop Autonomic Dysreflexia?

Yes. While it appears within weeks of an injury, Autonomic Dysreflexia typically presents during the chronic phase, developing three to six months after the initial event. It is a lifelong risk for those with injuries at or above the T6 level and emerges at any time.

Is it possible to manage Autonomic Dysreflexia entirely on my own at home?

Many mild episodes are managed at home by you or a trained caregiver, primarily by identifying and quickly removing the trigger. However, AD is a serious condition that requires a comprehensive management plan developed by your medical team. Severe episodes, particularly those where blood pressure remains high after checking for common triggers, are medical emergencies that require immediate professional intervention.

Is Autonomic Dysreflexia only caused by traumatic spinal cord injuries?

While most common after traumatic spinal cord injuries (like those from a car accident or fall), AD has also been reported in cases of non-traumatic spinal cord damage. This includes damage from tumors, infections, or other medical conditions like Guillain-Barré syndrome.

The insurance company for the at-fault driver is calling me. Should I tell them about these episodes?

You should not speak with the other party’s insurance adjuster about the specific details of your medical condition without first consulting a lawyer. Insurance companies are businesses, and their goal is to balance paying claims with remaining profitable. Any information you provide could be used to argue against the full value of your claim. It is best to let your lawyer manage all communications with the insurance company.

Are there specific resources in New Jersey for people with spinal cord injuries?

Yes, New Jersey is home to dedicated resources and world-class rehabilitation centers, including the renowned Kessler Institute for Rehabilitation. Navigating the healthcare system and support networks can be challenging after a catastrophic injury. As part of our comprehensive support for our clients, our firm helps connect you with local resources that aid in your recovery and daily life.

Take Control of Your Future After a Spinal Cord Injury

You should not have to pay for the financial costs of managing a lifelong medical condition caused by someone else’s carelessness. The legal process is your tool to secure the resources you need for your future medical care, adaptive equipment, and overall well-being.

Our role at Maggiano, DiGirolamo & Lizzi, P.C. is to handle that entire process for you, ensuring your story is told completely and the full impact of your injuries is understood.

Let us help you move forward. To discuss your spinal cord injury case and the challenges you are facing, call our team today at (201) 585-9111 for a complimentary discussion.