Review ArticleCardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury☆,☆☆
Section snippets
Sympathetic nervous system dysfunction in SCI
Maintenance of homeostasis within the body is a function of the autonomic nervous system and is interrupted when central nervous system (CNS) communications are interrupted. With high-level SCIs, the SNS is disproportionately involved when compared with the parasympathetic nervous system. In a complete high-level SCI, functioning in the isolated spinal cord below the lesion becomes independent of supraspinal control and has been termed “decentralization” of the SNS.3 Generally, the higher the
Reduced arterial pressure
Low blood pressure is a problem in both acute and chronic high-level SCI patients. In recently injured individuals with quadriplegia still in the acute stage of spinal shock, blood pressure is much lower than in normal controls.65 This lower blood pressure is regarded as secondary to a reduction in SNS activity below the level of SCI.12, 13 As Mathias and Frankel12, 13 have observed, it is unlikely that skeletal muscle paralysis accounts for low blood pressure as patients with flaccid
Summary
Cervical and high thoracic SCIs invariably result in significant SNS dysfunction. This SNS dysfunction can be largely attributed to several pathophysiological phenomena which occur below the level of SCI: (1) loss of supraspinal regulatory control; (2) reduced SNS outflow; (3) morphologic changes in sympathetic preganglionic neurons; and (4) peripheral alpha-adrenoceptor hyperresponsiveness. Reduced SNS outflow results in low resting blood pressure, orthostatic hypotension, reflex bradycardia,
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