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Severity of autonomic dysfunction in patients with complete spinal cord injury

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Abstract

Objective

There is limited information on the relationship between the level and completeness of the spinal cord injury (SCI) lesion and the degree of autonomic dysfunction. We aimed to study the impairment of sympathetic function in chronic SCI patients presenting with a motor and sensory complete lesion above T6.

Method

26 consecutive traumatic SCI patients were enrolled (14 tetraplegics and 12 paraplegics). They took a battery of tests that included pressor stimuli above (mental arithmetic, hand cold pressor test, sympathetic skin responses (SSR)) and below the lesion (foot cold pressor test, abdominal electrical stimulation), and Valsalva maneuver.

Results

All patients showed abolished plantar SSR, while a significant rise in systolic blood pressure in at least one of the pressor tests below the lesion was seen in all but one paraplegic patient. Palmar SSR and blood pressure overshoot at the end of the Valsalva maneuver were abolished in all tetraplegics, whereas at least one of those responses was seen in each paraplegic. Hand cold pressor test and mental arithmetic induced cardiovascular changes in most patients.

Conclusion

A complete loss of supraspinal control was observed in all, with a reflex isolated spinal cord in all but one patient. We confirm that in most SCI subjects there is concordance between the impairment of sympathetic function and somatic impairment. To assess autonomic dysfunction, a battery of tests should include SSR, abdominal electrical stimulation and Valsalva maneuver, as they combine pressor stimuli above and below the lesion and assess both cholinergic and sudomotor pathways.

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Acknowledgments

The authors are grateful to Isabelle Vaugier (CIC-IT Garches) for statistical assistance.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Autonomic Laboratory and Spinal Department, Centre Calvé, Fondation Hopale, 62600, Berck sur mer, France

    Jean G. Previnaire & Valerie Leclercq

  2. Laboratoire d’urodynamique et de sexologie, Centre Bouffard Vercelli Cap Peyrefite, Cerbère, 66290, France

    Jean M. Soler

  3. Service de Rééducation Neurologique, Hôpital Raymond Poincaré, 92380, Garches, France

    Pierre Denys

Authors
  1. Jean G. Previnaire
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  2. Jean M. Soler
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  3. Valerie Leclercq
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  4. Pierre Denys
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Corresponding author

Correspondence to Jean G. Previnaire.

Additional information

We state (1) that the manuscript is not being considered for publication elsewhere and will not be submitted elsewhere while under consideration for Clinical Autonomic Research, and that (2) the study was conducted in accordance with the Declaration of Helsinki.

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Previnaire, J.G., Soler, J.M., Leclercq, V. et al. Severity of autonomic dysfunction in patients with complete spinal cord injury. Clin Auton Res 22, 9–15 (2012). https://doi.org/10.1007/s10286-011-0132-8

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  • DOI: https://doi.org/10.1007/s10286-011-0132-8

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