Journal of Neurology

, Volume 253, Issue 7, pp 846–850

Skin vasomotor reflex responses in two contrasting groups of autonomic failure

Multiple system atrophy and pure autonomic failure
  • T. M. Young
  • M. Asahina
  • A. Nicotra
  • C. J. Mathias
ORIGINAL COMMUNICATION

Abstract

Background & Aim

A variety of stimuli such as deep inspiration, isometric exercise and mental arithmetic, result in a transient vasoconstriction,mediated by sympathetic efferent nerves, in the skin of the fingers and toes of healthy controls (Skin Vasomotor Reflex: SkVR). Multiple system atrophy (MSA) and pure autonomic failure (PAF) provide contrasting models of autonomic failure. In MSA the lesion is central and preganglionic, whilst in PAF the lesion site is peripheral and postganglionic. We evaluated the SkVR in response to various stimuli in MSA and PAF, to determine differences in skin vasomotor involvement between these two patient groups.

Methods

25 subjects (10 MSA, 7 PAF, 8 healthy controls) were studied. Baseline recordings of skin blood flow were obtained with a laser Doppler probe on the left index finger pulp and forearm. The subject then underwent a variety of stimuli with rest periods in between to reestablish baseline SkBF. These stimuli were: single deep inspiration (inspiratory gasp); mental arithmetic; bilateral leg elevation and cutaneous cold.

Results

Healthy control subjects demonstrated marked SkVRs on the finger pulp to each of the stimuli of a magnitude similar to those seen in previous studies, but no SkVRs on the forearm. In MSA SkVRs to inspiratory gasp on the finger pulp were reduced relative to controls. In PAF SkVRs were reduced relative to controls or MSA. The magnitude of SkVR response to gasp and cutaneous cold in PAF was significantly less than in healthy controls. In addition, the magnitude of the response in PAF was significantly less than in MSA for inspiratory gasp.

Conclusions

PAF showed a decreased SkVR response to all 4 stimuli, the response being significantly less than controls (for inspiratory gasp and cutaneous cold) or MSA (cutaneous cold inspiratory gasp). The decreased responses in PAF may reflect the extensive postganglionic sympathetic denervation seen in this group. The measurement of SkVR may therefore provide a non-invasive aid to the differentiation of MSA and PAF.

Key words

multiple system atrophy pure autonomic failure skin vasomotor reflex skin blood flow Laser Doppler 

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Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • T. M. Young
    • 1
    • 3
  • M. Asahina
    • 1
    • 2
  • A. Nicotra
    • 1
    • 3
  • C. J. Mathias
    • 1
  1. 1.Autonomic UnitNational Hospital for Neurology and Neurosurgery University College LondonLondonUK
  2. 2.Department of NeurologyChiba University Graduate, School of MedicineChibaJapan
  3. 3.Neurovascular Medicine Unit, Faculty of MedicineImperial College London at St.Mary’s Hospital 2nd floor, Queen Elizabeth The Queen, Mother WingLondon W2 1NYUK

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