Management of cardio-vascular abnormalities caused by autonomic dysfunction in spinal cord injury

Abstract

The activity of the autonomie nervous system is dependent on a cranial parasympathetic outflow and on spinal pathways, which traverse the cervical, thoracic, and lumbar sections of the spinal cord, with the sympathetic outflow emerging from the thoracic and upper lumbar segments, and the parasympathetic outflow from the sacral segments. In patients with spinal cord lesions the major proportion of the autonomie outflow may therefore be disrupted, resulting in inactivity, or dissociation of actions from cerebral regulation. A greater degree of disordered cardio-vascular control often occurs in patients with cervical and high thoracic spinal cord lesions. Activity of the autonomie nervous system, however, is also dependent on the afferent nervous system, and the level and extent of lesion thus influences responses. This chapter concentrates on the management of cardiovascular abnormalities which result from autonomie dysfunction in patients with high spinal cord injury. The initial description involves patients with acute lesions, as their cardio-vascular problems are often different from those in the chronic stages.

Management of autonomic dysreflexia associated with Charcot spinal arthropathy in a patient with complete spinal cord injury: Case report and review of the literature

“…Although the most common cause of autonomic dysreflexia is genitourinary affecting the bladder, large bowel, rectum, or anal canal, other causes include infection, muscle spasms, trauma, and syringomyelia. [ 10 13 20 21 24 25 ] In each of these cases, AD symptoms are relieved by sitting up. However, for the AD patient who has symptoms with movement, including exacerbation rather than relief on sitting up, the potential sources of noxious stimuli to consider should be the spine, hips, and sacrum.…”

Management of degenerative changes and stenosis of the lumbar spinal canal secondary to cervical spinal cord injury

“…[1][2][3] This can be explained by the intense linkage of these organs to the autonomic nervous system. Apart from this, autonomic dysreflexia can be caused by a large variety of disorders, many more than the ingrown toe-nail traditionally mentioned.…”