A person with a cervical or high thoracic spinal cord injury may develop intermittent clinical episodes caused by an excessive autonomic response to some visceral stimulus below the level of the spinal cord injury.


Patients at risk: T5 or higher (although it may occur with lesions at T10 or higher)


The clinical findings typically are episodic, triggered by a clinical stimulus and subsiding afterwards.


Clinical features may include:

(1) excessive sweating (diaphoresis) above the level of the injury

(2) flushing or patchy erythema of the face and neck

(3) congestion of the nasal passages and/or conjunctiva

(4) pilomotor erection and pallor below the level of the injury

(5) paroxysmal hypertension, which may be severe

(6) cardiac arrhythmia (tachycardia or bradycardia)

(7) severe throbbing headache

(8) confusion

(9) extreme anxiety, with an impending sense of doom

(10) nausea

(11) malaise

(12) respiratory distress

(13) mydriasis

(14) increased spasticity

(15) a metallic taste


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