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Effect of norepinephrine on spinal cord blood flow and parenchymal hemorrhage size in acute-phase experimental spinal cord injury

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Abstract

Purpose

In the acute phase of spinal cord injury (SCI), ischemia and parenchymal hemorrhage are believed to worsen the primary lesions induced by mechanical trauma. To minimize ischemia, keeping the mean arterial blood pressure above 85 mmHg for at least 1 week is recommended, and norepinephrine is frequently administered to achieve this goal. However, no experimental study has assessed the effect of norepinephrine on spinal cord blood flow (SCBF) and parenchymal hemorrhage size. We have assessed the effect of norepinephrine on SCBF and parenchymal hemorrhage size within the first hour after experimental SCI.

Methods

A total of 38 animals were included in four groups according to whether SCI was induced and norepinephrine injected. SCI was induced at level Th10 by dropping a 10-g weight from a height of 10 cm. Each experiment lasted 60 min. Norepinephrine was started 15 min after the trauma. SCBF was measured in the ischemic penumbra zone surrounding the trauma epicenter using contrast-enhanced ultrasonography. Hemorrhage size was measured repeatedly on parasagittal B-mode ultrasonography slices.

Results

SCI was associated with significant decreases in SCBF (P = 0.0002). Norepinephrine infusion did not significantly modify SCBF. Parenchymal hemorrhage size was significantly greater in the animals given norepinephrine (P = 0.0002).

Conclusion

In the rat, after a severe SCI at the Th10 level, injection of norepinephrine 15 min after SCI does not modify SCBF and increases the size of the parenchymal hemorrhage.

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References

  1. Cadotte DW, Fehlings MG (2011) Spinal cord injury: a systematic review of current treatment options. Clin Orthop Relat Res 469:732–741

    Article  PubMed Central  PubMed  Google Scholar 

  2. Broughton BR, Reutens DC, Sobey CG (2009) Apoptotic mechanisms after cerebral ischemia. Stroke 40:331–339

    Article  Google Scholar 

  3. Wallace MC, Tator CH, Frazee P (1986) Relationship between posttraumatic ischemia and hemorrhage in the injured rat spinal cord as shown by colloidal carbon angiography. Neurosurgery 18:433–439

    Article  CAS  PubMed  Google Scholar 

  4. Noble LJ, Wrathall JR (1989) Correlative analyses of lesion development and functional status after graded spinal cord contusive injuries in the rat. Exp Neurol 103:34–40

    Article  CAS  PubMed  Google Scholar 

  5. Blight AR (1983) Cellular morphology of chronic spinal cord injury in the cat: analysis of myelinated axons by line-sampling. Neuroscience 10:521–543

    Article  CAS  PubMed  Google Scholar 

  6. Shen XF, Zhao Y, Zhang YK et al (2009) A modified ferric tannate method for visualizing a blood vessel and its usage in the study of spinal cord injury. Spinal Cord 47:852–856

    Article  PubMed  Google Scholar 

  7. Mautes AE, Weinzierl MR, Donovan F et al (2000) Vascular events after spinal cord injury: contribution to secondary pathogenesis. Phys Ther 80:673–687

    CAS  PubMed  Google Scholar 

  8. Heiss WD (2010) The concept of the penumbra: can it be translated to stroke management? Int J Stroke 5:290–295

    Article  PubMed  Google Scholar 

  9. Casha S, Christie S (2011) A systematic review of intensive cardiopulmonary management after spinal cord injury. J Neurotrauma 28:1479–1495

    Article  PubMed Central  PubMed  Google Scholar 

  10. Ploumis A, Yadlapalli N, Fehlings MG et al (2010) A systematic review of the evidence supporting a role for vasopressor support in acute SCI. Spinal Cord 48:356–362

    Article  CAS  PubMed  Google Scholar 

  11. Muzevich KM, Voils SA (2009) Role of vasopressor administration in patients with acute neurologic injury. Neurocrit Care 11:112–119

    Article  PubMed  Google Scholar 

  12. Consortium for Spinal Cord Medicine (2008) Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 31:403–479

    Google Scholar 

  13. Guha A, Tator CH, Piper I (1987) Effect of a calcium channel blocker on posttraumatic spinal cord blood flow. J Neurosurg 66:423–430

    Article  CAS  PubMed  Google Scholar 

  14. Guha A, Tator CH, Smith CR et al (1989) Improvement in post-traumatic spinal cord blood flow with a combination of a calcium channel blocker and a vasopressor. J Trauma 29:1440–1447

    Article  CAS  PubMed  Google Scholar 

  15. Guha A, Tator CH, Rochon J (1989) Spinal cord blood flow and systemic blood pressure after experimental spinal cord injury in rats. Stroke 20:372–377

    Article  CAS  PubMed  Google Scholar 

  16. Martirosyan NL, Feuerstein JS, Theodore N et al (2011) Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions. J Neurosurg Spine 15:238–251

    Article  PubMed  Google Scholar 

  17. Soubeyrand M, Laemmel E, Dubory A, Vicaut E, Court C, Duranteau J (2012) Real-time and spatial quantification using contrast-enhanced ultrasonography of spinal cord perfusion during experimental spinal cord injury. Spine (Phila Pa 1976) 37(22):1376–1382. doi:10.1097/BRS.0b013e318269790f

    Article  Google Scholar 

  18. Soubeyrand M, Laemmel E, Court C, Dubory A et al (2013) Rat model of spinal cord injury preserving dura mater integrity and allowing measurements of cerebrospinal fluid pressure and spinal cord blood flow. Eur Spine J 22:1810–1819

    Article  PubMed  Google Scholar 

  19. Fehlings MG, Tator CH, Linden RD (1989) The relationships among the severity of spinal cord injury, motor and somatosensory evoked potentials and spinal cord blood flow. Electroencephalogr Clin Neurophysiol 74:241–259

    Article  CAS  PubMed  Google Scholar 

  20. Fehlings MG, Tator CH, Linden RD (1989) The effect of nimodipine and dextran on axonal function and blood flow following experimental spinal cord injury. J Neurosurg 71:403–416

    Article  CAS  PubMed  Google Scholar 

  21. Dolan EJ, Tator CH (1980) The treatment of hypotension due to acute experimental spinal cord compression injury. Surg Neurol 13:380–384

    CAS  PubMed  Google Scholar 

  22. Wallace MC, Tator CH (1987) Successful improvement of blood pressure, cardiac output, and spinal cord blood flow after experimental spinal cord injury. Neurosurgery 20:710–715

    Article  CAS  PubMed  Google Scholar 

  23. Wallace MC, Tator CH (1986) Failure of naloxone to improve spinal cord blood flow and cardiac output after spinal cord injury. Neurosurgery 18:428–432

    Article  CAS  PubMed  Google Scholar 

  24. Gambardella G, Collufio D, Caruso GN et al (1995) Experimental incomplete spinal cord injury: treatment with a combination of nimodipine and adrenaline. J Neurosurg Sci 39:67–74

    CAS  PubMed  Google Scholar 

  25. Ross IB, Tator CH (1991) Further studies of nimodipine in experimental spinal cord injury in the rat. J Neurotrauma 8:229–238

    Article  CAS  PubMed  Google Scholar 

  26. Dyste GN, Hitchon PW, Girton RA et al (1989) Effect of hetastarch, mannitol, and phenylephrine on spinal cord blood flow following experimental spinal injury. Neurosurgery 24:228–235

    Article  CAS  PubMed  Google Scholar 

  27. Parke WW (2004) Arteriovenous glomeruli of the human spinal cord and their possible functional implications. Clin Anat 17:558–563

    Article  PubMed  Google Scholar 

  28. Bozzo A, Marcoux J, Radhakrishna M et al (2011) The role of magnetic resonance imaging in the management of acute spinal cord injury. J Neurotrauma 28:1401–1411

    Article  PubMed Central  PubMed  Google Scholar 

  29. Willmot M, Leonardi-Bee J, Bath PM (2004) High blood pressure in acute stroke and subsequent outcome: a systematic review. Hypertension 43:18–24

    Article  CAS  PubMed  Google Scholar 

  30. Levi L, Wolf A, Belzberg H (1993) Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery 33:1007–1016 (discussion 16–17)

    Article  CAS  PubMed  Google Scholar 

  31. Vale FL, Burns J, Jackson AB et al (1997) Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 87:239–246

    Article  CAS  PubMed  Google Scholar 

  32. Anderson DK, Nicolosi GR, Means ED et al (1978) Effects of laminectomy on spinal cord blood flow. J Neurosurg 48:232–238

    Article  CAS  PubMed  Google Scholar 

  33. Griffiths IR, Trench JG, Crawford RA (1979) Spinal cord blood flow and conduction during experimental cord compression in normotensive and hypotensive dogs. J Neurosurg 50:353–360

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

None of the authors received funding for the present study. Stephanie Gorgeard (Toshiba, France) and Christophe Lazare (Bracco, France) are acknowledged.

Conflict of interest

The ultrasound device was lent by the society Toshiba, but none of the authors received fundings from Toshiba.

Bioethic committee

All the methods used in this experimental animal study were approved by the bioethics committee of the Lariboisière School of Medicine, Paris, France. Reference = CEEALV/2011-08-01.

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Authors and Affiliations

  1. “Microcirculation, Bioénergétique, Inflammation et Insuffisance Circulatoire Aiguë”, Equipe Universitaire 3509 Paris VII-Paris XI-Paris XIII, Paris, France

    Marc Soubeyrand, Arnaud Dubory, Elisabeth Laemmel, Eric Vicaut & Jacques Duranteau

  2. Service de Chirurgie Orthopédique, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, 78 Rue Général Leclerc, Le Kremlin-Bicêtre, France

    Marc Soubeyrand, Arnaud Dubory & Charles Court

  3. Département d’Anesthésie Réanimation, Service d’Anesthésie Réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Université Paris Sud-11, 78 Rue Général Leclerc, Le Kremlin-Bicêtre, 94275, France

    Jacques Duranteau

Authors
  1. Marc Soubeyrand
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  2. Arnaud Dubory
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  3. Elisabeth Laemmel
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  4. Charles Court
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  5. Eric Vicaut
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  6. Jacques Duranteau
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Corresponding author

Correspondence to Marc Soubeyrand.

Additional information

A. Dubory and E. Laemmel have equally contributed to this work. E. Vicaut and J. Duranteau have equally contributed to this work.

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Soubeyrand, M., Dubory, A., Laemmel, E. et al. Effect of norepinephrine on spinal cord blood flow and parenchymal hemorrhage size in acute-phase experimental spinal cord injury. Eur Spine J 23, 658–665 (2014). https://doi.org/10.1007/s00586-013-3086-9

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  • DOI: https://doi.org/10.1007/s00586-013-3086-9

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