Autonomic dysreflexia: a potentially fatal complication of somatic stress in quadriplegics

A 44-year-old patient with known, stable, long-standing quadriplegia sustained a midshaft left femur fracture in a motor vehicle accident. He presented to the emergency department (ED) two days after the accident with a chief complaint of a swollen left thigh. Management in the ED included x-ray studies and some incidental manipulation during the process of examination and splinting. While awaiting discharge, the patient, although asymptomatic, was observed to be very profusely diaphoretic above the level of his cord lesion. Blood pressure was then noted to be 230/110, far above his admission blood pressure of 110/70. A diagnosis of autonomic dysreflexia was made and the patient admitted for treatment. Fracture manipulation in the ED is herein reported to be one of the many types of acute traumatic and atraumatic somatic stresses that can cause this serious and occasionally lethal syndrome. Signs and symptoms that need to be watched for are discussed.