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Autonomic dysreflexia in tetraplegic patients: Evidence for α-adrenoceptor hyper-responsiveness

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Abstract

A controlled study of acute pharmacological intervention was designed to determine whether decreased sympathetic nerve activity in tetraplegic patients results in increased responsiveness of α-adrenoceptors which might contribute to vascular hyperreactivity and the clinical scenario of autonomic dysreflexia. The study took place in a university teaching hospital and included six male tetraplegic patients and six age-matched normal male controls. All tetraplegics were 5 months or longer post-traumatic spinal cord injury and all had experienced symptoms of autonomic dysreflexia on at least one occasion. The dorsal foot vein diameter was recorded with a tonometer during local infusions of noradrenaline 0.125–256 ng/min given through a short intravenous needle. In tetraplegic patients, there was a significant shift to the left of the dose—response curve indicating increased venous responsiveness to noradrenaline. The concentration of noradrenaline required to cause a 50% reduction of the resting vein diameter was decreased in tetraplegics (1.6 ng/min, geometric mean) compared to normal controls (10.9 ng/min,p < 0.02). α-Adrenoceptor responsiveness in dorsal foot veins is increased in patients with tetraplegia. Hypersensitivity of vascular α-adrenoceptors may contribute to autonomic dysreflexia in patients with high spinal cord injury.

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References

  1. Mathias CJ, Frankel HL. Cardiovascular system in tetraplegia and paraplegia. In: Frankel HL, ed.Handbook of Clinical Neurology, Vol. 17 (61),Spinal Cord Trauma. Amsterdam: Elsevier Science Publishers, 1992; 435–456.

    Google Scholar 

  2. Mathias CJ, Christensen NJ, Corbett JL, Frankel HL, Spalding JMK. Plasma catecholamines during paroxysmal neurogenic hypertension in tetraplegic man.Circ Res 1976;39: 204–208.

    PubMed  Google Scholar 

  3. Wallin BG, Stjernberg L. Sympathetic activity in man after spinal cord injury: outflow to skin below the lesion.Brain 1984;107: 183–198.

    PubMed  Google Scholar 

  4. Debarge O, Christensen NJ, Corbett JL, Eidelman BH, Frankel HL, Mathias CJ. Plasma catecholamines in tetraplegics.Paraplegia 1978;12: 44–49.

    Google Scholar 

  5. Erickson RP. Autonomic hyperreflexia: pathophysiology and medical management.Arch Phys Med Rehabil 1980;61: 431–440.

    PubMed  Google Scholar 

  6. Lindan R. Loiner E. Freehafer AAet al. Incidence and clinical features of autonomic dysreflexia in patients with spinal cord injury.Paraplegia 1980;18: 285–292.

    PubMed  Google Scholar 

  7. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I.Paraplegia 1969;7: 179–192.

    PubMed  Google Scholar 

  8. Alradi A, Carruthers SG. Evaluation and application of the linear variable differential transformer technique for the assessment of human dorsal hand vein α-receptor activity.Clin Pharmacol Ther 1985;38: 495–502.

    PubMed  Google Scholar 

  9. Arnold JMO, McLeod AP, Teasell RW, Brown JE, Carruthers SG. Increased venous α-adrenoceptor responsiveness in patients with reflex sympathetic dystrophy.Ann Intern Med 1993;118: 619–621.

    PubMed  Google Scholar 

  10. Aellig.WH. Clinical pharmacology, physiology and pathophysiology of superficial veins — 1 & 2.Br J Clin Pharmacol 1994;38: 181–196, 289–305.

    PubMed  Google Scholar 

  11. Hjelmdahl P, Daleskog M, Kahan T. Determination of plasma catecholamines by high performance liquid chromatography with electrochemical detection, comparison with a radioenzymatic method.Life Sci 1979;25: 131–138.

    PubMed  Google Scholar 

  12. Wallenstein S, Zucker CL, Fleiss JL. Some statistical methods useful in circulation research.Circ Res 1980;47: 1–9.

    PubMed  Google Scholar 

  13. Mathias CJ, Frankel HL, Christensen NJ, Spalding JMK. Enhanced pressor response to noradrenalin in patients with cervical spinal cord transection.Brain 1976;99: 757–770.

    PubMed  Google Scholar 

  14. Braddom RL, Rocco JF. Autonomic dysreflexia: a survey of current treatment.Am J Phys Med Rehabil 1991;70: 234–241.

    PubMed  Google Scholar 

  15. Krum H, Louis WJ, Brown DJ, Clarke SJ, Fleming JA, Howes LG. Cardiovascular and vasoactive hormone responses to bladder distension in spinal and normal man.Paraplegia 1992;30: 348–354.

    PubMed  Google Scholar 

  16. Krum H, Brown DJ, Rowe PR, Louis WJ, Howes LG. Steady state plasma [3H]-noradrenaline kinetics in tetraplegic chronic spinal cord injury patients.J Auton Pharmacol 1990;10: 221–226.

    PubMed  Google Scholar 

  17. Kongpatanakul S, Blaschke TF, Hoffman BB. The role of postsynaptic α2-adrenoceptors in human hand veins.Clin Res 1990;38: 94.

    Google Scholar 

  18. Kongpatanakul S, Blaschke TF, Hoffman BB. The role of postsynaptic α2-adrenoceptors in human hand veins.Clin Pharmac Ther 1990;47: 141.

    Google Scholar 

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Authors and Affiliations

  1. Victoria Hospital, University of Western Ontario, 375 South Street, N6A 4G5, London, Ontario, Canada

    J. M. O. Arnold MD (FRCP FRCPC FACP FACC) & Q. -P. Feng MD PhD

  2. Parkwood Hospital, University of Western Ontario, London, Ontario, Canada

    G. A. Delaney MD (FRCPC)

  3. University Hospital, University of Western Ontario, London, Ontario, Canada

    R. W. Teasell MD (FRCPC)

Authors
  1. J. M. O. Arnold MD
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  2. Q. -P. Feng MD PhD
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  3. G. A. Delaney MD
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  4. R. W. Teasell MD
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Arnold, J.M.O., Feng, Q.P., Delaney, G.A. et al. Autonomic dysreflexia in tetraplegic patients: Evidence for α-adrenoceptor hyper-responsiveness. Clinical Autonomic Research 5, 267–270 (1995). https://doi.org/10.1007/BF01818891

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  • DOI: https://doi.org/10.1007/BF01818891

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