Autonomic dysreflexia is a medical emergency in patients with spinal cord injury above which level?

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Autonomic dysreflexia happens when a spinal cord injury disrupts the brain’s ability to regulate reflex sympathetic activity below the level of injury. When the injury is above T6, a noxious or sensory stimulus below the lesion—such as bladder distension, bowel impaction, or skin irritation—triggers a massive, unmodulated sympathetic surge. This causes widespread vasoconstriction below the level of the injury, leading to a dangerous rise in blood pressure. The baroreceptors respond by increasing parasympathetic (vagal) activity, which can produce bradycardia and vasodilation above the level of injury, but cannot reverse the severe hypertension below the lesion because the spinal pathways are blocked.

Because of the potential for severe complications like stroke, seizure, or myocardial infarction, this situation is a medical emergency when the injury is at or above the T6 level. Promptly identify and relieve the triggering stimulus (for example, check and decompress the bladder, assess for bowel impaction, loosen restrictive clothing) and position the patient upright to reduce blood pressure; additional antihypertensive therapy may be needed if blood pressure remains dangerously high.