Autonomic dysreflexia (AD) may complicate spinal cord injured (SCI) subjects with a lesion level above the sixth thoracic level. There are several ways to remove triggering factors and, furthermore, new trigger mechanisms may be added by the introduction of new treatments. New data about the pathogenic mechanisms have been suggested in recent years as well as signs of metabolic effects associated with the reaction. This review of the syndrome includes clinical aspects of the AD reaction; the known pathogenic mechanisms, the incidence and prevalence and triggering factors. AD is associated with some cases of severe morbidity, including cerebral haemorrhage, seizures and pulmonary oedema. Symptomatic as well as specific treatments are discussed. Finally, some further questions are raised by the necessity of a proper definition of the syndrome, the revealing of the underlying pathophysiology, and new investigations concerning incidence and prevalence.