Which symptom is characteristic of autonomic dysreflexia above the level of spinal injury?

• A. Dizziness only below the injury
• B. Numbness in lower extremities
• C. Sweating and skin flushing above the level of injury
• D. Severe chest pain

Answer: (C)

Autonomic dysreflexia is a dangerous reaction that occurs in people with spinal cord injuries at or above the mid-thoracic level (often T6 or higher). A noxious stimulus below the injury (like a full bladder or bowel distension) triggers an unregulated sympathetic surge, causing widespread vasoconstriction below the level of injury and a dramatic rise in blood pressure. The brain can respond with parasympathetic signals, but these signals can reach only above the injury. As a result, you get sweating and flushing of the skin above the level of injury, while below the level the skin may feel cool and pale from vasoconstriction. This combination of high blood pressure with above-level sweating and flushing is the classic sign. Dizziness, numbness, or severe chest pain aren’t characteristic features of autonomic dysreflexia itself and point to other issues, though chest pain would require urgent evaluation for cardiac causes.