A 32-year-old man with a C5 spinal cord injury from a road traffic accident 3 months ago develops sudden severe headache, profuse sweating above the neck, facial flushing, and blood pressure 210/130 mmHg with heart rate 52 bpm. What is the most likely diagnosis?
- A Malignant hypertension
- B Autonomic dysreflexia ✓
- C Pheochromocytoma crisis
- D Hypertensive encephalopathy
Correct answer: B. Autonomic dysreflexia
Explanation
Autonomic dysreflexia occurs in patients with spinal cord lesions at or above T6. A noxious stimulus below the lesion level triggers a massive sympathetic reflex causing severe paroxysmal hypertension, while the compensatory baroreflex causes bradycardia. Common triggers include bladder distension, fecal impaction, or pressure sores. Management involves sitting the patient upright, loosening clothing, and identifying and removing the trigger. Short-acting antihypertensives such as nifedipine or nitrates may be needed.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.