To the Editor.—
I found the article entitled "Hypertensive Emergencies and Urgencies"1 interesting and informative. I wish to point out that the authors neglected to mention one very important, albeit unusual, entity. Autonomic dysreflexia, or hyperreflexia, is a common hypertensive emergency in the injured patient with a spinal cord lesion above the T-7 level. It is a syndrome characteristically associated with the sudden onset of hypertension, headache, bradycardia, sweating, flushing, dilated pupils, and blurred vision and has been reported to occur in up to 85% of quadriplegic patients.Autonomic dysreflexia results from increased reflex activity within the nervous system precipitated by noxious stimuli below the level of injury, most often bladder distention. It is at times associated with other abnormal medical conditions including deep venous thrombosis, ingrown toenails, pressure sores, and fecal impaction. Treatment of the associated hypertension is important since seizures and cerebral hemorrhage have been reported. Usually
Pelligra SJ. Severe Hypertension due to Autonomic Dysreflexia. JAMA. 1986;256(9):1137. doi:10.1001/jama.1986.03380090065015
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