A 20-year-old man with a C4 complete spinal cord injury (ASIA A) is admitted to the ICU on day 2 post-injury. He develops severe headache, facial flushing, and hypertension (BP 210/110) during bladder catheterization. The most likely diagnosis is:
- A Malignant hyperthermia
- B Neurogenic shock
- C Autonomic dysreflexia ✓
- D Pheochromocytoma
Correct answer: C. Autonomic dysreflexia
Explanation
Autonomic dysreflexia occurs in patients with spinal cord injuries at or above T6, typically after resolution of spinal shock. A noxious stimulus below the level of injury (commonly bladder distension or catheterization) triggers massive sympathetic discharge causing severe hypertension, headache, flushing, and sweating above the lesion, with compensatory bradycardia. Neurogenic shock is hypotension with bradycardia, occurring early in acute SCI. The hypertension here is pathognomonic.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.