Which sign is typically observed below the level of spinal injury during autonomic dysreflexia?

• A. Warm, flushed skin
• B. Pale, cool skin with no sweating
• C. Distended neck veins
• D. Headache

Answer: (B)

Autonomic dysreflexia happens when a noxious stimulus below a spinal cord injury triggers an unchecked sympathetic response. The brain cannot modulate this response, so vessels below the injury constrict strongly. That vasoconstriction reduces skin perfusion, making the skin below the level pale and cool, and sweating in that region is typically absent. Meanwhile, above the injury you may see flushing and sweating as a reflex attempting to lower blood pressure. The rapid rise in blood pressure can also cause headache. So, the sign below the level of injury is pale, cool, dry skin due to vasoconstriction.