Brain, Vol 121, Issue 9 1711-1719, Copyright © 1998 by Oxford University Press
AK Karlsson, P Friberg, P Lonnroth, L Sullivan and M Elam
Centrally mediated sympathetic stimulation of subjects who have suffered a
spinal cord injury (SCI) does not activate the decentralized part of the
body below the level of the lesion, whereas experimental data indicate an
exaggerated response above the level of the lesion. SCI subjects may
exhibit an autonomic dysreflexia reaction following afferent stimulation
below the level of the lesion. In order to investigate the function of the
sympathetic nervous system above and below the level of the lesion,
regional noradrenaline spillover was measured by means of steady-state
isotope dilution technique above (forearm) and below (leg) the level of the
lesion at baseline, during mental stress and following bladder stimulation
in nine SCI subjects (mean age 41 years; level of injury C7-T4; mean
duration of injury 13.8 years). The results from the SCI subjects were also
compared with those from 10 weight- and age-matched control subjects, both
at rest and during mental stress. Body composition was determined by dual
energy X- ray absorptiometry scanning and arm/leg blood flow by occlusion
plethysmography. At baseline, total and regional noradrenaline spillover
did not differ between the groups. Mental stress increased mean arterial
pressure in both groups. Heart rate (76 versus 64 beats/min; P < 0.05)
and arm noradrenaline spillover (2.73 versus 1.71 pmol/min/100 g; P <
0.05) increased more in spinal cord injury subjects than in control
subjects, whereas total body (2826 versus 3783 pmol/min; P < 0.01) and
leg noradrenaline spillover (0.23 versus 0.41 pmol/min/100 g; P < 0.05)
increased only in the control group. During bladder stimulation, SCI
subjects reacted with a marked increase in mean arterial pressure and leg
noradrenaline spillover (from 0.06 to 0.91 pmol/min/100 g; P < 0.05) and
their leg blood flow decreased. Regional and total noradrenaline clearance
were similar in the two groups. In conclusion, peripheral afferent
stimulation below the level of the lesion in spinal cord injury subjects
gives rise to a marked noradrenaline spillover from the decentralized part
of the sympathetic nervous system suggesting a remaining, but qualitatively
altered, neuronal function. Centrally mediated stimulation induced an
exaggerated response above the level of the lesion.
ARTICLES
Regional sympathetic function in high spinal cord injury during mental stress and autonomic dysreflexia
Spinal Injury Unit, Institute of Clinical Neuroscience, University of Goteborg, Sweden.
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