Cold pressor test in tetraplegia and paraplegia suggests an independent role of the thoracic spinal cord in the hemodynamic responses to cold

Catz, Amiram; Bluvshtein, Vadim; Pinhas, I.; Akselrod, Solange; Gelernter, Ilana; Nissel, T; Vered, Yaffa; Bornstein, Natan M.; Korczyn, Amos D.

doi:10.1038/sj.sc.3102055

Cited by 16 publications

(20 citation statements)

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“…The additional tests, detailed elsewhere, [11][12][13][14] include the HUT examinations performed before and after the meal. The HUT could have confounded the effect of the liquid meal, but it was not found to influence glucose or insulin levels, before or after the meal, irrespective of group, consistent with former observations in healthy men.…”

Section: Controlmentioning

confidence: 99%

“…In the present experiments, which were part of a larger study, [11][12][13][14] we compared glucose and insulin responses to a standard meal and head-up tilt (HUT) in a group of patients with mid-thoracic, below T 4 , SCI, with responses of patients with cervical SCI and of healthy subjects. We also compared the insulin response to meal with post-prandial changes in low frequency (LF)/high frequency (HF) ratio, the LF/HF heart rate (HR) variations power values.…”

Section: Introductionmentioning

confidence: 99%

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Insulin resistance in tetraplegia but not in mid-thoracic paraplegia: is the mid-thoracic spinal cord involved in glucose regulation?

et al. 2010

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Study design: Controlled experimental human study. Objectives: To assess insulin resistance (IR) in tetraplegia and paraplegia, and the role of the spinal cord (SC) in glucose regulation. Setting: Laboratory of Spinal Research, Loewenstein Rehabilitation Hospital. Methods: Glucose and insulin levels and the heart rate variation spectral components LF (low frequency), HF (high frequency) and LF/HF were studied at supine rest, head-up tilt and after a standard meal in three groups: 13 healthy subjects, 7 patients with T 4 -T 6 paraplegia and 11 patients with C 4 -C 7 tetraplegia. Results: Glucose and insulin increased significantly after the meal in all groups (Po0.001). Glucose increased significantly more in the tetraplegia than in the other groups (Po0.01). Increases in insulin level tended to accompany increases in LF/HF after the meal in the tetraplegia and control groups but not in the paraplegia group. Conclusion: Post-prandial IR appears in C 4 -C 7 but not in T 4 -T 6 SC injury. The results of the study, combined with previously published findings, are consistent with the hypotheses that IR is related to activation of the sympathetic nervous system, and that below T 4 the mid-thoracic SC is involved in the regulation of glucose and insulin levels.

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Section: Controlmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Insulin resistance in tetraplegia but not in mid-thoracic paraplegia: is the mid-thoracic spinal cord involved in glucose regulation?

et al. 2010

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“…11,14,15,17 The widespread involvement of the vasculature below the lesion suggests the spread of neuronal impulses intraspinally, resulting in a marked reduction in peripheral blood flow, which may result in cold limbs. 15 As the pressor stimuli below the lesion add sensitivity to the SkARV test, 5 we recommend its association with clinical tests, such as PVS, cystometry, cutaneous cold 18 or electrical stimulation. 10 Admittedly, SkARV test has its limitations: it is only suggested as a simple bedside clinical test.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the sympathetic level of lesion in patients with spinal cord injury

Prévinaire

Soler²,

Masri

et al. 2008

Spinal Cord

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Study design: To study the vasomotor responses (skin axon-reflex vasodilatation (SkARV) to stimulation of the skin in spinal cord injury (SCI) patients. Objective: To assess the completeness of the sympathetic injury and to define the sympathetic level of lesion in paraplegic and tetraplegic patients. Setting: Centre Calve, Fondation Hopale and Centre Bouffard-Vercelli, France. Subjects: A total of 81 SCI patients ranging from C2 to L2. Method: A mechanical stimulation was applied to the skin on both sides of the trunk, using a blunt instrument. The presence of an abnormal response below the lesion helped define the sympathetic level. Results: Above the lesion, SkARV was observed in all patients. In patients with a complete sympathetic injury, the response below the lesion was either a vasoconstrictor response in upper motor neuron lesions, or total absence of SkARV in lower motor neuron lesions. There was excellent correspondence between complete somatic (American Spinal Injury Association (ASIA) A) and complete sympathetic lesions (100% of paraplegic and 94% of tetraplegic patients), whereas an incomplete somatic (ASIA B-D) lesion was often associated with a complete sympathetic lesion. In 34% of complete ASIA A patients, a sympathetic zone of partial preservation was found, extending below the lesion on sensory denervated dermatomes. Conclusion: SkARV is a simple bedside test that allows the assessment of sympathetic completeness of injury across the lesion as well as the excitability of the isolated spinal cord. We suggest that the definition of sympathetic level should be part of the classification of complete thoracic SCI.

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“…Neurological levels of injury were determined using the International Standards for the Neurological Classification of Spinal Cord Injury and SCI severity was determined using the American Spinal Injury Association Impairment Scale (AIS). 9 The 10 T 4 -T 6 paraplegia and 11 C 4 -C 7 tetraplegia SCI participants were patients who could be enrolled during the study period from the above T 7 SCI patients admitted to the Spinal Department of Loewenstein Rehabilitation Hospital for rehabilitation or check-up. The control subjects were nine men and four women who were 34 ± 13 years old.…”

Section: Subjectsmentioning

confidence: 99%

“…Several publications show that cardiovascular impairments may be expressed differently in cervical and thoracic SCI, and that the autonomic deficit following thoracic SC lesions may have a specific clinical significance. [3][4][5] Responses to liquid food ingestion, cold application to the hand and cold application to the foot [6][7][8] indicated that the hemodynamic changes are mediated by a mid-thoracic SC mechanism. But data showing a role for the mid-thoracic SC in the control of hemodynamic changes in the upright position has been scarce.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic responses to head-up tilt after spinal cord injury support a role for the mid-thoracic spinal cord in cardiovascular regulation

et al. 2010

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Background: Data showing a role for the mid-thoracic spinal cord (SC) in the control of hemodynamic changes is scarce despite existing evidence for its involvement in autonomic regulation. Study design: On the basis of the open label prospective series comparing three groups. Objective: To determine whether the mid-thoracic SC has a role in hemodynamic regulation during head-up tilt (HUT). Setting: Spinal Research Laboratory, Loewenstein Rehabilitation Hospital. Methods: A total of 13 healthy control subjects, 10 patients with T 4 -T 6 paraplegia and 11 with C 4 -C 7 tetraplegia were examined during supine rest and during HUT. Heart rate (HR), blood pressure (BP), HR spectral components (lower frequency fluctuation (LF), higher frequency fluctuations (HF) and LF/HF) and cerebral blood flow velocity (CBFV) were continuously measured or calculated. Results: BP response to HUT differed among these groups (Po0.02). During HUT, BP decreased markedly in the tetraplegia group (from a mean value of 81.65 to 67.69 mm Hg), and increased in the control groups (from 92.89 to 95.44 mm Hg) and in the T 4 -T 6 paraplegia group (from 96.24 to 97.86 mm Hg). Significant correlation was found in the control and tetraplegia groups between increases in HR LF/HF and HR at HUT (r40.7; Po0.01). No such correlation was found in the paraplegia group. HUT effect on HR and CBFV was significant in all groups (Po0.001), but group differences were statistically non-significant. Conclusion: Findings were generally compatible with those of comparable previously published studies, but they also support a role for the mid-thoracic SC in hemodynamic regulation, which should be considered in clinical setting and in research.

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Cold pressor test in tetraplegia and paraplegia suggests an independent role of the thoracic spinal cord in the hemodynamic responses to cold

Cited by 16 publications

References 14 publications

Insulin resistance in tetraplegia but not in mid-thoracic paraplegia: is the mid-thoracic spinal cord involved in glucose regulation?

Insulin resistance in tetraplegia but not in mid-thoracic paraplegia: is the mid-thoracic spinal cord involved in glucose regulation?

Assessment of the sympathetic level of lesion in patients with spinal cord injury

Hemodynamic responses to head-up tilt after spinal cord injury support a role for the mid-thoracic spinal cord in cardiovascular regulation

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