A 30-year-old man with a T4 complete spinal cord injury (AIS A) develops acute severe headache, profuse sweating above the level of injury, nasal congestion, and a blood pressure of 210/130 mmHg with a heart rate of 50/min. The most likely diagnosis is:
- A Neurogenic shock
- B Malignant hypertension
- C Autonomic dysreflexia ✓
- D Pheochromocytoma
Correct answer: C. Autonomic dysreflexia
Explanation
Autonomic dysreflexia occurs in spinal cord injuries at T6 or above, triggered by a noxious stimulus below the lesion (commonly bladder distension or fecal impaction). It causes uncontrolled sympathetic discharge with severe hypertension, flushing and sweating above the lesion, and compensatory bradycardia via the baroreceptor reflex. It is a medical emergency. Neurogenic shock presents with hypotension and bradycardia acutely after injury, not episodic hypertension.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.