Autonomic Consequences of Spinal Cord Injury

Hou, Shaoping; Rabchevsky, Alexander G.

doi:10.1002/cphy.c130045

Cited by 179 publications

(130 citation statements)

References 372 publications

(420 reference statements)

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“…(32) Following T5–T6 blunt spinal cord injury (SCI), rats have been shown to exhibit neurogenic shock for three minutes after injury with mean arterial pressure (MAP) decrease by 78% and mean heart rate decrease by 63%. (33) Both heart rate and MAP returned to basal values within 20 minutes, demonstrating the transient nature of autonomic dysfunction following SCI in this model.…”

Section: Spinal Cord Injurymentioning

confidence: 99%

β-Blockade use for Traumatic Injuries and Immunomodulation

Loftus

Efron

Moldawer

et al. 2016

Shock

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Sympathetic nervous system activation and catecholamine release are important events following injury and infection. The nature and timing of different pathophysiologic insults have significant effects on adrenergic pathways, inflammatory mediators, and the host response. Beta adrenergic receptor blockers (β-blockers) are commonly used for treatment of cardiovascular disease but recent data suggests that the metabolic and immunomodulatory effects of β-blockers can expand their use. β-blocker therapy can reduce sympathetic activation and hypermetabolism as well as modify glucose homeostasis and cytokine expression. It is the purpose of this review to examine either the biologic basis for proposed mechanisms or to describe current available clinical evidence for the use of β-blockers in traumatic brain injury (TBI), spinal cord injury (SCI), hemorrhagic shock, acute traumatic coagulopathy, erythropoietic dysfunction, metabolic dysfunction, pulmonary dysfunction, burns, immunomodulation, and sepsis.

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Section: Spinal Cord Injurymentioning

confidence: 99%

β-Blockade use for Traumatic Injuries and Immunomodulation

Loftus

Efron

Moldawer

et al. 2016

Shock

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“…We know that spinal cord lesions in general can lead to a broad range of autonomic abnormalities. This is explained by disruption of connections between higher brain centers and the spinal cord or impairment of the autonomic system itself [7]. Diagnosis is made preferentially by spinal MRI because its capabilities for tissue differentiation [8].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous spinal epidural hematoma in two toddlers: diagnostic pitfalls

Smeets¹,

Akker²,

Peters³

et al. 2016

Pediatr Dimensions

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We report two boys with a spontaneous spinal epidural hematoma (SSEH). The first child presented at the age of 2 years with back pain and general weakness after a respiratory tract infection. After a first surgical intervention he developed a recurrence of bleeding, necessitating re-intervention. He developed medullary ischemia. Important neurologic deficits with paresis of the lower extremities and bladder dysfunction persisted. The other child presented at the age of 1,5 years with irritability and crying, attributed to a mesenteric lymphadenitis. He underwent a laminectomy with drainage of the hematoma. The postoperative course was uneventful. In both cases, no identifiable cause was found for the bleeding. SSEH is a rare condition, but represents a medical emergency. In most pediatric cases, presentation is atypical with back or neck pain and general irritability as sole initial symptom. Neurologic focal signs can arise hours or days after the onset of the bleeding. Knowledge of SSEH presenting signs and symptoms is important for timely diagnosis and treatment. Although it is mostly a solitary event, we stress the importance of close clinical, and if necessary radiological, follow up.

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“…Traumatic spinal cord injuries (SCIs) are devastating for patients due to the sudden and irreversible loss of motor, sensory and autonomic functions at and below the level of injury ( Hou & Rabchevsky, 2014; Scivoletto et al , 2014). It is estimated that as many as 500,000 people suffer a spinal cord injury every year ( World Health Organization, 2013) with each incident requiring lifelong medical care amounting to approximately $USD 3.5–6.8 million over the course of a lifetime.…”

Section: Introductionmentioning

confidence: 99%

Selective inhibition of ASIC1a confers functional and morphological neuroprotection following traumatic spinal cord injury

et al. 2016

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Tissue loss after spinal trauma is biphasic, with initial mechanical/haemorrhagic damage at the time of impact being followed by gradual secondary expansion into adjacent, previously unaffected tissue. Limiting the extent of this secondary expansion of tissue damage has the potential to preserve greater residual spinal cord function in patients. The acute tissue hypoxia resulting from spinal cord injury (SCI) activates acid-sensing ion channel 1a (ASIC1a). We surmised that antagonism of this channel should provide neuroprotection and functional preservation after SCI. We show that systemic administration of the spider-venom peptide PcTx1, a selective inhibitor of ASIC1a, improves locomotor function in adult Sprague Dawley rats after thoracic SCI. The degree of functional improvement correlated with the degree of tissue preservation in descending white matter tracts involved in hind limb locomotor function. Transcriptomic analysis suggests that PcTx1-induced preservation of spinal cord tissue does not result from a reduction in apoptosis, with no evidence of down-regulation of key genes involved in either the intrinsic or extrinsic apoptotic pathways. We also demonstrate that trauma-induced disruption of blood-spinal cord barrier function persists for at least 4 days post-injury for compounds up to 10 kDa in size, whereas barrier function is restored for larger molecules within a few hours. This temporary loss of barrier function provides a “ treatment window” through which systemically administered drugs have unrestricted access to spinal tissue in and around the sites of trauma. Taken together, our data provide evidence to support the use of ASIC1a inhibitors as a therapeutic treatment for SCI. This study also emphasizes the importance of objectively grading the functional severity of initial injuries (even when using standardized impacts) and we describe a simple scoring system based on hind limb function that could be adopted in future studies.

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Autonomic Consequences of Spinal Cord Injury

Cited by 179 publications

References 372 publications

β-Blockade use for Traumatic Injuries and Immunomodulation

β-Blockade use for Traumatic Injuries and Immunomodulation

Spontaneous spinal epidural hematoma in two toddlers: diagnostic pitfalls

Selective inhibition of ASIC1a confers functional and morphological neuroprotection following traumatic spinal cord injury

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