Is autonomic dysreflexia a cause of respiratory dysfunction after spinal cord injury?

Spinal cord injury can impair the respiratory system and lead to respiratory insufficiency, a significant cause of mortality and morbidity. Autonomic dysreflexia (AD) is the result of parasympathetic imbalance, resulting from a massive, unrestrained outpouring of norepinephrine. Breathing difficulty is a common symptom and sign, but the vagal response may be responsible for the respiratory changes reported. This case report describes a patient with T4 AIS A spinal cord injury in which AD led to acute respiratory insufficiency. During hamstring stretching exercises, the patient developed AD and was diagnosed with acute respiratory insufficiency with desaturation and hypercapnia. The patient fully recovered from the signs and symptoms of AD with the cessation of noxious stimulation and oxygen administration. The association between AD and acute respiratory insufficiency has not been previously described in spinal cord injury literature.

• 1
  The study found an association between autonomic dysreflexia (AD) and acute respiratory insufficiency in a patient with a T4 spinal cord injury.
• 2
  Hamstring stretching triggered an episode of AD, leading to desaturation, hypercapnia, and other symptoms, including hypertension, sweating and headache.
• 3
  The acute vagal response to the systemic sympathetic activation causes constriction of the pulmonary airways, or bronchospasms, leading to type-2 respiratory insufficiency.