In patients with spinal cord injury and neurogenic bladder, what autonomic complication should be monitored?

• A. Orthostatic hypotension
• B. Autonomic dysreflexia
• C. Seizures
• D. Hypoglycemia

Answer: (B)

When working with spinal cord injury and neurogenic bladder, the most important autonomic issue to monitor is autonomic dysreflexia. This reflex happens when a noxious stimulus below the level of the injury, commonly bladder distension or urinary retention, triggers an uncontrolled sympathetic response. Because supraspinal control is lost, the body below the injury constricts blood vessels, causing a sudden and potentially dangerous rise in blood pressure. The result can be a pounding headache, sweating or flushing above the level of injury, nasal congestion, and sometimes vision changes or bradycardia. It is a medical emergency because if the high blood pressure persists, it can lead to stroke, seizures, or other serious complications.

In the context of a neurogenic bladder, bladder issues are a frequent trigger, so monitoring for these signs and acting quickly to relieve the bladder is essential. Start by sitting the patient up to help lower blood pressure, check and relieve any bladder outlet obstruction—ensure the catheter is patent and draining, and remove tight clothing or anything constrictive. If the blood pressure remains elevated after these steps, follow the established treatment protocol for autonomic dysreflexia, which may include medications and further medical evaluation.

Orthostatic hypotension, while common in SCI, is not the reflexive, acute emergency that autonomic dysreflexia represents. Seizures and hypoglycemia are not primarily tied to the autonomic dysreflexia process in the setting of neurogenic bladder.