A patient with acute spinal cord injury at the T4 level presents with sudden throbbing headache, diaphoresis above the level of injury, nasal congestion, and severe hypertension (BP 210/115 mmHg) accompanied by bradycardia (HR 48 bpm). What life-threatening condition is this patient experiencing?

Answer and explanation

Correct answer: B. Autonomic Dysreflexia (Hyperreflexia)

  1. Step 1: Autonomic dysreflexia occurs in patients with spinal cord lesions at or above T6 in response to a noxious stimulus below the injury (most commonly a distended urinary bladder or impacted bowel).
  2. Step 2: Unchecked sympathetic discharge below the lesion causes severe vasoconstriction and malignant hypertension, while baroreceptor activation triggers vagal parasympathetic bradycardia and vasodilation above the lesion.
Answer
Autonomic Dysreflexia (Hyperreflexia).
Why not the others: 'Spinal shock' refers to the acute, temporary loss of all reflex activity and flaccidity below the level of cord transection; 'Neurogenic shock' causes hypotension and bradycardia due to loss of sympathetic tone; 'Cushing triad' features hypertension, bradycardia, and irregular respirations due to brainstem herniation.

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