Autonomic Dysreflexia and Catecholamines

To the Editor: Cryer's excellent review of normal and abnormal sympathoadrenal function in the August 21 issue contained a fleeting reference to hypoadrenergic postural hypotension secondary to spinal-cord dysfunction. However, no mention was made of another characteristic pathophysiologic state: the syndrome of autonomic dysreflexia. First described by Head and Riddoch in 1917, ¹ this syndrome is characterized by excessive sweating, flushing of the face, nasal congestion, pilomotor responses, headache, paroxysmal hypertension, and bradycardia. It occurs in patients with spinal-cord lesions at or above the mid-thoracic level, as an exaggerated autonomic response to such stimuli as a distended bladder or rectum.² A.