An unusual presentation of autonomic dysreflexia in a patient with cold abscess of cervical spine for anterolateral decompression

A young female having complaints of quadriparesis along with bladder and bowel involvement, diagnosed to have osseous destruction of C(4), C(6), C(7), T(2) vertebral bodies with pre- and para-vertebral abscess, was taken up for anterolateral decompression and fusion of cervical spine. She presented with anxiety, agitation, sweating and headache and was in hypertensive crisis which was refractory to antihypertensives, anxiolytics and analgesics but showed a reasonable response to intravenous dexmedetomidine and finally responded dramatically to rectal evacuation. Autonomic dysreflexia was suspected with stimulus arising from distended rectum as all other causes of hypertension were ruled out.