Dysreflexic dilemma: do we need a revised definition for autonomic dysreflexia?

Autonomic dysreflexia (AD) is widely recognized as a potentially serious secondary health complication of spinal cord injury (SCI) and comprises an abnormal autonomic nervous system response to sensory stimuli below the lesion. The hallmark feature of AD is hypertension that persists until the precipitating sensory stimulus is removed. AD can be highly symptomatic, with a negative impact on quality of life, and can be associated with significant morbidity and mortality if not correctly identified and appropriately managed. A key component of the clinical identification and management of AD is the definition used to operationalize patient care and guide at-home monitoring. In addition, research seeking to further understanding of the underlying pathophysiology and to identify novel management approaches for AD, both at the bench and at the bedside, will benefit from broader consideration of AD criteria and clarifying the definition of what is, and is not, AD. Here we describe some strengths and weaknesses of the current definition in the context of the pathophysiology and impact of the condition, and raise the question as to whether alternate or additional criteria might be of benefit. …