Death and life-threatening sequelae associated with autonomic dysreflexia revisited

Autonomic dysreflexia (AD) is a life-threatening condition among individuals with spinal cord injury (SCI) that has garnered increased attention, given the dangerous immediate and long-term sequelae if left untreated. In 2014, a clinical review was published to highlight cases of AD associated with life-threatening outcomes and mortality.

The objective of our study was to provide an update on life-threatening sequelae and cases of mortality secondary to AD described in the literature.

A review was done through an online search to identify cases in the literature describing life-threatening sequelae of AD and mortality. A search was conducted on databases including Embase, PubMed, and Scopus to identify relevant articles published between 2013 and 2024. Our search yielded fifteen eligible articles describing eighteen cases of life-threatening AD.

Two (11%) cases resulted in mortality. Fifteen (83%) cases resulted in CNS complications and three cases (17%) resulted in cardiovascular complications of AD. Bowel and bladder triggers were responsible for most cases of AD (89%), including the two mortality casesy. One of the cases, which resulted in mortality, was asymptomatic.

Relatively few cases of life-threatening sequelae of AD have been reported in the literature over the last ten years. This could be related to increasing recognition of AD, timely management, and improved outcomes. Monitoring cardiovascular health remains a critical component of longitudinal care for individuals with SCI to prevent cardiovascular and neurological sequelae.