The Automatic Bladder, Excessive Sweating and Some Other Reflex Conditions, in Gross Injuries of the Spinal Cord

Head, Henry; Riddoch, George

doi:10.1093/brain/40.2-3.188

Cited by 361 publications

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“…It is well documented that in tetraplegic individuals there is a block of the sympathetic medullary efferents and a syndrome of autonomic hyperreflexia has been well described in tetraplegics and high thoracic lesion paraplegics (Head and Riddoch, 1917;Guttmann, 1947;Silver, 1971). In many textbooks of anatomy and physiology the sympathetic contribution to the cardiac plexus is mentioned to be somewhere between Tl and T6.…”

Section: Discussionmentioning

confidence: 99%

Relationship between heart rate and oxygen uptake in thoracic level paraplegics

Bar-On

Nene

1990

Spinal Cord

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SummaryIn able-bodied subjects heart rate and oxygen uptake have a linear relation up to submaximal workloads. Cardiac response to exercise or physical stress is described to be under the control of the sympathetic nervous system. Various workers have claimed that the sympathetic contribution to the cardiac plexus arises between thoracic spinal cord levels Tl and T6. Paraplegics are participating in various sporting activities in increasing numbers. Theoretically, assessing the progress of physical fitness of paraplegics with lesions above T6 by monitoring heart rate alone becomes unreliable because of damage to their sympathetic system. Forty-four paraplegics with lesion levels between T3 and TIO were put through an arm cranking exercise routine with increasing power levels. Their heart rate and oxygen uptake was measured for each power level. For analytical purposes the subjects were grouped into two groups according to their lesion level. All the subjects with the lesion at T6 or above were in one group and the other group consisted of lesion at T7 or below.Almost linear relation was found between the heart rate and oxygen uptake in all subjects of both groups.The findings of this study suggest that either the sympathetic contribution comes from above spinal level T3, or the cardiac response to an increased demand in physical exercise is controlled by some other mechanism.

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Section: Discussionmentioning

confidence: 99%

Relationship between heart rate and oxygen uptake in thoracic level paraplegics

Bar-On

Nene

1990

Spinal Cord

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“…Head soon recognised Riddoch's neurological ability, and a long and fruitful partnership ensued, resulting in a collaborative paper on 'The autonomic bladder, excessive sweating and reflex conditions in gross injuries of the spinal cord' (1917). 3 After the 1914-1918 war, having established a firm reputation as a neurologist, Riddoch sought to further his clinical experience, and through the Medical Research Council (MRC) he joined the newly formed Medical Unit at the London Hospital and also worked at the Hospital for Epilepsy and Paralysis in Maida Vale. In 1924, he was elected as a supernumerary assistant physician to the London Hospital, and was appointed to the staff of the National Hospital, Queen Square.…”

Section: George Riddoch MD Frcp (1888-1947)mentioning

confidence: 99%

George Riddoch: the man who found Ludwig Guttmann

Silver

Weiner

2011

Spinal Cord

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“…However, again, spinal shock has been described in patients with incomplete lesions. 5 In patients with lesions above T6, Lindan 11 found no cases of autonomic dysre¯exia in the ®rst month, while Kewalramani 12 13 that hypertension can occur in recently injured tetraplegics during blood or saline infusion.…”

Section: Discussionmentioning

confidence: 99%

“…Two further cases have been identi®ed in the literature. 5 These four cases would indicate that there is re¯ex autonomic activity at a spinal level in the stage of spinal shock.…”

Section: Introductionmentioning

confidence: 99%

Early autonomic dysreflexia

Silver

2000

Spinal Cord

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Introduction: During the stage of spinal shock the conventional view is that autonomic activity is abolished. Here, evidence is presented that autonomic activity is still present. Patients: Four patients with acute cord transactions are presented: one new case and three from the literature. De®nitions: The de®nitions of spinal shock and autonomic dysre¯exia are given. Methods: All four cases showed acute autonomic dysre¯exia between 7 and 31 days after acute cord transection at a stage when the tendon re¯exes were abolished. Results: Two cases showed a severe rise in blood pressure; the two earlier cases, before blood pressure was routinely recorded, profuse sweating. In two cases autonomic dysre¯exia was obtained when the bladder was overdistended with 1000 ml and 1600 ml. In the other two cases it occurred in response to traumatic catheterisation. This was found when supramaximal stimuli were applied. It has not been recorded routinely as, with modern management, the bladder does not get overdistended or traumatised. Discussion: Other evidence, the blood pressure, and urethral tone is presented to show that sympathetic re¯ex activity of the cord is not abolished during spinal shock. Clinical signi®cance: The clinical importance of this is that autonomic dysre¯exia can be seen at an early stage and it should be considered in the di erential diagnosis of a sick patient immediately after spinal injury. Spinal Cord (2000) 38, 229 ± 233

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The Automatic Bladder, Excessive Sweating and Some Other Reflex Conditions, in Gross Injuries of the Spinal Cord

Cited by 361 publications

References 0 publications

Relationship between heart rate and oxygen uptake in thoracic level paraplegics

Relationship between heart rate and oxygen uptake in thoracic level paraplegics

George Riddoch: the man who found Ludwig Guttmann

Early autonomic dysreflexia

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