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Hyperreflexia

Hyperreflexia Definition

Hyperreflexia is a condition that affects the autonomic nervous system and gives rise to overactive responses as well as various other serious problems. It is characterized by overactive and overresponsive reflexes.

The disorder is also often referred to as Autonomic Dysreflexia or Autonomic Hyperreflexia.

Hyperreflexia Causes

The autonomic nervous system controls various involuntary functions like breathing, blood pressure, pulse, digestion as well as regulation of body temperature. The autonomic nervous system responds abnormally due to Hyperreflexia which leads to imbalance and over-stimulation. It can be caused by a spinal cord injury, an upper motor neuron disorder or certain other factors.

Picture of Hyperreflexia

Picture 1 - Hyperreflexia

Spinal cord injury and bladder problems are the most common causes for this disease. There can also be numerous other stimuli that can be causative factors for this disorder. Painful or uncomfortable sensations before a spinal cord injury can lead to autonomic dysreflexia after spinal cord injury. The urinary drainage device can get blocked by several bladder conditions, such as:

  • Cystitis or bladder infection
  • Bladder spasms
  • Inadequate emptying of bladder
  • Stones in bladder

This may lead to overfilling of bladder and give rise to hyperreflexic symptoms.

The condition can also occur if the bowel is full of gas or stool and a stimulus is sent to the rectum. In 85% of all cases of the disease, bowel impaction or bladder distention is held as the main reason. Other probable causes include:

  • Wounds
  • Skin irritation
  • Burns
  • Pressure sores
  • Pregnancy
  • Broken bones
  • Appendicitis
  • Ingrown toenails
  • Various other medical complications

The various factors that might lead to the development of the disorder are listed below:

Bowel problems

These include:

  • Constipation or impaction
  • Irritation or over distention
  • Digital stimulation or distention during a bowel program
  • Anal fissures or Haemorrhoids
  • Irritation or infection such as appendicitis

Bladder issues

These involve:

  • Bladder stones
  • Blocked catheter
  • Urinary retention
  • Urinary tract infection
  • An overfilled collection bag
  • Overstretching or irritation of the bladder walls
  • Noncompliance with an intermittent catheterization program

Skin-related Disorders

These include:

  • Burns
  • Ingrown toenails
  • Pressure sores or decubitus ulcer
  • A sensation of direct irritation below one’s level of injury
  • Tight and restrictive clothing or pressure on skin from wrinkled clothing

Sexual Activity

These involve:

  • Menstrual cramps
  • Labor pain and delivery
  • Overstimulation during sexual activity

Other causes

Various other causes of the disease include:

  • Stroke
  • Tetanus
  • Preeclampsia
  • Hyperthyroidism
  • Skeletal fractures
  • Spinal cord lesions
  • Portal hypertension
  • Serotonin syndrome
  • Heterotopic ossification
  • Guillain-Barre syndrome
  • Side effects of medication
  • Subarachnoid hemorrhage
  • Hypernatraemia or Electrolyte imbalance
  • Severe head trauma or other brain injuries
  • Using illegal stimulant drugs like cocaine and amphetamines
  • Acute abdominal conditions, such as colitis, peritonitis and gastric ulcer

Hyperreflexia Symptoms

The various symptoms of this disorder are listed below:

  • Fever
  • Nausea
  • Fainting
  • Seizures
  • Vomiting
  • Slow Pulse
  • Indigestion
  • Blurry vision
  • Restlessness
  • Goosebumps
  • Heavy sweating
  • Nasal congestion
  • Irregular heartbeat
  • Throbbing headache
  • Stool inconsistencies
  • Cool and clammy skin
  • Detrusor Hyperreflexia
  • Worrying or anxiousness
  • Difficulty while urinating
  • High or low blood pressure
  • Severe weakness or fatigue
  • Flushing or skin turning red
  • Bowel or bladder problems
  • Dizziness or light-headedness
  • Muscle spasms, mostly in the jaw

 

Some individuals with the disorder may not display any definite symptoms at all, except an abnormal rise in the blood pressure.

Hyperreflexia Diagnosis

While diagnosing Hyperreflexia, a doctor is likely to perform a complete medical and nervous system examination. The patient or his/her family members should inform the doctor about all the medications that the individual is taking as well as the entire medical history. This will make it easier for the doctor to determine which tests need to be conducted.

The various diagnostic tests for Hyperreflexia include the following:

  • X-Rays
  • MRI or CT Scan
  • Lumbar puncture
  • Urine and blood tests
  • EKG Test, which measures the electrical activity of the heart
  • Tilt-table testing, which involves testing the blood pressure in keeping with the changes of the body position
  • Toxicology screening, for detecting any drugs or medications that might be present in the bloodstream

Hyperreflexia Differential Diagnosis

There are certain conditions that have symptoms similar to that of Hyperreflexia, even though the underlying causes behind these disorders are different. The differential diagnosis for the disease include telling its symptoms from those of the following conditions:

Image of Hyperreflexia

Picture 2 – Hyperreflexia Image

  • Thyroid storm
  • Carcinoid syndrome
  • Serotonin syndrome
  • Neuroleptic malignant syndrome

Hyperreflexia Prevention

In order to avoid this disorder, one should avoid the medications that may cause it or may aggravate the already existing symptoms.

Those having a spinal cord injury should take the necessary precautions in order to avoid the development of Hyperreflexia symptoms.

  • Keep the pain level low
  • Prevent bladder infections
  • Avoid overfilling of the bladder
  • Take care of the skin to avoid skin infections and bedsores
  • Practice necessary bowel care for avoiding stool impaction

Hyperreflexia Treatment

Since Hyperreflexia is a life-threatening condition, it needs to be treated as quickly as possible. A person having symptoms of this disorder should try to relax, sit upright with a raised head and remove all tight clothing.

Proper treatment of the disease depends on its underlying causes. If any drugs or medications are causing these symptoms, they should be stopped immediately. Any illness that might give rise to the symptoms require immediate treatment.

If a slow heart rate is the root cause of the symptoms, the patient might be treated with a class of drugs known as anticholinergics. Atropine is such a drug.

If the blood pressure rises too high, it needs to be quickly brought down. However it should be done carefully as it is possible for the blood pressure to drop suddenly. The various emergency drugs used for reducing high blood pressure include the following:

  • Mecamylamine (Inversine)
  • Diazoxide (Hyperstat)
  • Nitroglycerin
  • Nifedipine (Procardia)
  • Phenoxybenzamine hydrochloride (Dibenzyline)

A doctor might also have to employ a pacemaker to cure unstable heart rhythm.

Hyperreflexia Complications

Complications might occur due to the side effects of the medications. Cardiac arrest can occur if pulse rate drops significantly. A severely high blood pressure lasting for a long time may cause seizures, stroke, bleeding in eyes or even death.

Hyperreflexia Prognosis

The outcome of the disorder depends essentially on the underlying causative factors. People who have Hyperreflexia due to the usage of medications generally recover once the problematic medications are stopped. When the disorder results from other health conditions, recovery depends completely on how effectively the other disease can be resolved.  With timely diagnosis and proper treatment, a patient has a high chance of making a good recovery.

 

References:

http://neurology.healthkosh.com/medical/autonomic-hyperreflexia/

http://www.freemd.com/autonomic-hyperreflexia/overview.htm

http://calder.med.miami.edu/pointis/automatic.html

http://www.apparelyzed.com/autonomic.html

By   Last updated November 16th, 2012

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