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Wulf MJ, Tom VJ. Consequences of spinal cord injury on the sympathetic nervous system. Front Cell Neurosci 2023; 17:999253. [PMID: 36925966 PMCID: PMC10011113 DOI: 10.3389/fncel.2023.999253] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
Spinal cord injury (SCI) damages multiple structures at the lesion site, including ascending, descending, and propriospinal axons; interrupting the conduction of information up and down the spinal cord. Additionally, axons associated with the autonomic nervous system that control involuntary physiological functions course through the spinal cord. Moreover, sympathetic, and parasympathetic preganglionic neurons reside in the spinal cord. Thus, depending on the level of an SCI, autonomic function can be greatly impacted by the trauma resulting in dysfunction of various organs. For example, SCI can lead to dysregulation of a variety of organs, such as the pineal gland, the heart and vasculature, lungs, spleen, kidneys, and bladder. Indeed, it is becoming more apparent that many disorders that negatively affect quality-of-life for SCI individuals have a basis in dysregulation of the sympathetic nervous system. Here, we will review how SCI impacts the sympathetic nervous system and how that negatively impacts target organs that receive sympathetic innervation. A deeper understanding of this may offer potential therapeutic insight into how to improve health and quality-of-life for those living with SCI.
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Affiliation(s)
| | - Veronica J. Tom
- Marion Murray Spinal Cord Research Center, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
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Thomas AX, Riviello JJ, Davila-Williams D, Thomas SP, Erklauer JC, Bauer DF, Cokley JA. Pharmacologic and Acute Management of Spinal Cord Injury in Adults and Children. Curr Treat Options Neurol 2022; 24:285-304. [PMID: 35702419 PMCID: PMC9184374 DOI: 10.1007/s11940-022-00720-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review This review provides guidance for acute spinal cord injury (SCI) management through an analytical assessment of the most recent evidence on therapies available for treating SCI, including newer therapies under investigation. We present an approach to the SCI patient starting at presentation to acute rehabilitation and prognostication, with additional emphasis on the pediatric population when evidence is available. Recent Findings Further studies since the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) demonstrated a potential functional outcome benefit with ultra-early surgical intervention ≤ 8 h post-SCI. Subsequent analysis of the National Acute Spinal Cord Injury Study (NASCIS) II and NASCIS III trials have demonstrated potentially serious complications from intravenous methylprednisolone with limited benefit. Newer therapies actively being studied have demonstrated limited or no benefit in preclinical and clinical trials with insufficient evidence to support use in acute SCI treatment. Summary Care for SCI patients requires a multi-disciplinary team. Immediate evaluation and management are focused on preventing additional injury and restoring perfusion to the affected cord. Rapid assessment and intervention involve focused neurological examination, targeted imaging, and surgical intervention when indicated. There are currently no evidence-based recommendations for pathomechanistically targeted therapies.
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Affiliation(s)
- Ajay X. Thomas
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX USA
| | - James J. Riviello
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - Daniel Davila-Williams
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - Sruthi P. Thomas
- Division of Pediatric Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX USA
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Houston, TX USA
| | - Jennifer C. Erklauer
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - David F. Bauer
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Houston, TX USA
| | - Jon A. Cokley
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Department of Pharmacy, Baylor College of Medicine, Houston, TX USA
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Cerebral Vasospasm-Left Heart Failure-Cerebral Infarction May Be a Potential Pathophysiological Mechanism of Malignant Cerebral Vasospasm. J Craniofac Surg 2022; 33:e419-e421. [PMID: 35013071 DOI: 10.1097/scs.0000000000008350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Cerebral vasospasm (CV) and delayed cerebral ischemia are serious complications after ruptured aneurysm with high mortality and disability rate. However, there are few reports of cardiogenic CV, the mechanism is unclear, and the treatment recommended by the guidelines is not detailed. This article describes in detail a 47-year-old woman with intracranial aneurysm rupture and hemorrhage. After interventional operation, left heart failure worsened CV and cerebral infarction. This article summarizes the diagnosis and treatment process of patients in detail, summarizes the treatment strategies of cardiogenic CV, and elaborates the pathological mechanism of CV-left heart failure-CV and cerebral infarction. Increase new understanding of the clinical diagnosis and treatment strategies of cardiogenic CV.
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Standl T, Annecke T, Cascorbi I, R. Heller A, Sabashnikov A, Teske W. The Nomenclature, Definition and Distinction of Types of Shock. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:757-768. [PMID: 30573009 PMCID: PMC6323133 DOI: 10.3238/arztebl.2018.0757] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 09/28/2017] [Accepted: 08/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND A severe mismatch between the supply and demand of oxygen is the common feature of all types of shock. We present a newly developed, clinically oriented classification of the various types of shock and their therapeutic implications. METHODS This review is based on pertinent publications (1990-2018) retrieved by a selective search in PubMed, and on the relevant guidelines and meta-analyses. RESULTS There are only four major categories of shock, each of which is mainly related to one of four organ systems. Hypovolemic shock relates to the blood and fluids compartment while distributive shock relates to the vascular system; cardiogenic shock arises from primary cardiac dysfunction; and obstructive shock arises from a blockage of the circulation. Hypovolemic shock is due to intravascular volume loss and is treated by fluid replacement with balanced crystalloids. Distributive shock, on the other hand, is a state of relative hypovolemia resulting from pathological redistribution of the absolute intravascular volume and is treated with a combination of vasoconstrictors and fluid replacement. Cardiogenic shock is due to inadequate function of the heart, which shall be treated, depending on the situation, with drugs, surgery, or other interventional procedures. In obstructive shock, hypoperfusion due to elevated resistance shall be treated with an immediate life-saving intervention. CONCLUSION The new classification is intended to facilitate the goal-driven treatment of shock in both the pre-hospital and the inpatient setting. A uniform treatment strategy should be established for each of the four types of shock.
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Affiliation(s)
- Thomas Standl
- Department of Anesthesiology, Intensive and Palliative Care Medicine, Städtisches Klinikum Solingen gGmbH
| | - Thorsten Annecke
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne
| | - Ingolf Cascorbi
- Institute of Clinical and Experimental Pharmacology at the University Medical Center Schleswig-Holstein, Campus Kiel
| | - Axel R. Heller
- Surgical Center/Emergency Department, Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Cardiac Center, University Hospital of Cologne
| | - Wolfram Teske
- Department of Orthopedics and Trauma Surgery, Kath. Krankenhaus Hagen gGmbH
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Bauman WA, Wecht JM, Biering-Sørensen F. International spinal cord injury endocrine and metabolic extended data set. Spinal Cord 2017; 55:466-477. [DOI: 10.1038/sc.2016.164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 10/21/2016] [Indexed: 01/27/2023]
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Park SH, Cho KH. Large-Dose Glucocorticoid Induced Secondary Adrenal Insufficiency in Spinal Cord Injury. Ann Rehabil Med 2016; 40:1033-1039. [PMID: 28119833 PMCID: PMC5256326 DOI: 10.5535/arm.2016.40.6.1033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/14/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To investigate the incidence of adrenal insufficiency (AI) in patients with spinal cord injury (SCI) with symptoms similar to those of AI and to assess the relevance of AI and large-dose glucocorticoids in SCI. METHODS The medical records of 228 patients who were admitted to the rehabilitation center after SCI from January 2014 to January 2016 were reviewed retrospectively. Twenty-nine of 228 patients had persistent symptoms suspicious for AI despite continuous care for more than 4 weeks. Therefore, adrenocorticotropic hormone (ACTH) stimulation tests were conducted in these 29 patients. RESULTS Twelve of these 29 patients (41.4%) with SCI who manifested AI-like symptoms were diagnosed as having AI. Among these 29 patients, 15 patients had a history of large-dose glucocorticoid treatment use and the other 14 patients did not have such a history. Ten of the 15 patients (66.7%) with SCI treated with large-dose glucocorticoids after injury were diagnosed as having AI. In 12 patients with AI, the most frequent symptom was fatigue (66%), followed by orthostatic dizziness (50%), and anorexia (25%). In the chi-square test, the presence of AI was positively correlated with large-dose glucocorticoid use (p=0.008, Fisher exact test). CONCLUSION Among the patients with SCI who manifested similar symptoms as those of AI, high incidence of AI was found especially in those who were treated with large-dose glucocorticoids. During management of SCI, if a patient has similar symptoms as those of AI, clinicians should consider the possibility of AI, especially when the patient has a history of large-dose glucocorticoid use. Early recognition and treatment of the underlying AI should be performed.
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Affiliation(s)
- Soo Ho Park
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Kang Hee Cho
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, Korea
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Lemley K, Bauer P. Pediatric Spinal Cord Injury: Recognition of Injury and Initial Resuscitation, in Hospital Management, and Coordination of Care. J Pediatr Intensive Care 2015; 4:27-34. [PMID: 31110847 DOI: 10.1055/s-0035-1554986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Spinal cord injury is uncommon in the pediatric population with a lifelong impact for the patient and family. Knowledge of spine embryology, mechanisms of injury that lead to specific injuries, appropriate utilization of radiographic imaging based on suspected injury, prehospital and hospital management of various spinal cord injuries is essential for providers attending to traumatically injured patients. In addition to patients who present with soft tissue and bony injuries diagnosed with clinical examination and confirmed with computed tomography or magnetic resonance imaging, it is important to note that the pediatric population is at a higher risk for spinal cord injury without radiographic abnormality than the adult population. Patients who survive the acute phase of injury face long-term rehabilitation and have an increased risk of depression and mortality. Understanding the long-term sequelae of spinal cord injuries is also an essential management component of traumatically injured children. A program that provides long-term rehabilitation, psychosocial and spiritual support, and adaptive environmental supports gives patients and their families the best opportunity for long-term recovery. A review of the current literature on the diagnosis, management, and follow-up of pediatric spinal cord injury is presented.
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Affiliation(s)
- Kyle Lemley
- Department of Pediatric Critical Care, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
| | - Paul Bauer
- Department of Pediatric Critical Care, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
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Yang H, Trbovich M, Harrow J. Secondary adrenal insufficiency after glucocorticosteroid administration in acute spinal cord injury: a case report. J Spinal Cord Med 2014; 37:786-90. [PMID: 24969098 PMCID: PMC4231968 DOI: 10.1179/2045772314y.0000000223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT/BACKGROUND A 61-year-old female with cervical stenosis underwent an elective cervical laminectomy with post-op worsening upper extremity weakness. Over the first 3 weeks post-op, she received two separate courses of intravenous steroids. Two days after cessation of steroids, she presented with non-specific symptoms of adrenal insufficiency (AI). Initial formal diagnostic tests of random cortisol level and 250 µg cosyntropin challenge were non-diagnostic; however, symptoms resolved with the initiation of empiric treatment with hydrocortisone. Ten days later, repeat cosyntropin (adrenocortocotropic hormone stimulation) test confirmed the diagnosis of AI. FINDINGS AI is a potentially life-threatening complication of acute spinal cord injury (ASCI), especially in those receiving steroids acutely. Only three cases have been reported to date of AI occurring in ASCI after steroid treatment. The presenting symptoms can be non-specific (as in this patient) and easily confused with other common sequelae of ASCI such as orthostasis and diffuse weakness. The 250 µg cosyntropin simulation test may not the most sensitive test to diagnose AI in ASCI. CONCLUSION The non-specific presentations and variability of diagnosis criteria make diagnosis more difficult. One microgram cosyntropin simulation test may be more sensitive than higher dose. Clinicians should be aware that AI can be a potential life-threatening complication of ASCI post-steroid treatment. Prompt diagnosis and treatment can reverse symptoms and minimize mortality.
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Affiliation(s)
- Huiqing Yang
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at San Antonio, TX, USA
| | - Michelle Trbovich
- Correspondence to: Michelle Trbovich, Department of Rehabilitation Medicine, UT Health Science Center San Antonio, Mail Code 7798, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900, USA.
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Lerch JK, Puga DA, Bloom O, Popovich PG. Glucocorticoids and macrophage migration inhibitory factor (MIF) are neuroendocrine modulators of inflammation and neuropathic pain after spinal cord injury. Semin Immunol 2014; 26:409-14. [DOI: 10.1016/j.smim.2014.03.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW This article provides an overview of the neurologic complications found in the various endocrine disorders affecting adult patients. Specifically, disorders in pituitary hormones (prolactin, growth hormone, vasopressin, and oxytocin), thyroid hormones, adrenal hormones (glucocorticoids), and sex hormones (estrogen and testosterone) will be covered, with an emphasis on identifying the signs and symptoms in addition to diagnosing and managing these disorders. RECENT FINDINGS Hyperthyroidism in the young was found to increase the risk for ischemic stroke in a recent prospective case-cohort study. The cognitive effects of hormonal therapy in postmenopausal women remain controversial, but a recent study found no benefit or risk in cognitive function when treating younger (50 to 55 years of age) postmenopausal women with hormonal therapy. SUMMARY Endocrine disorders can cause various neurologic complications, from insidious myopathy to acute encephalopathy. Diagnosing the endocrine disorder as the cause of the neurologic impairment is essential, as treating the underlying hormonal dysfunction will often rapidly reverse the neurologic symptoms. Ongoing research is needed to further clarify the role of hormonal dysfunction in neurologic disorders.
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Maurin O, de Régloix S, Caballé D, Arvis AM, Perrochon JC, Tourtier JP. [Traumatic neurogenic shock]. ACTA ACUST UNITED AC 2013; 32:361-3. [PMID: 23566590 DOI: 10.1016/j.annfar.2013.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 02/14/2013] [Indexed: 11/26/2022]
Abstract
Traumatic neurogenic shock is a rare but serious complication of spinal cord injury. It associates bradycardia and hypotension caused by a medullary trauma. It is life-threatening for the patient and it aggravates the neurological deficit. Strict immobilization and a quick assessment of the gravity of cord injury are necessary as soon as prehospital care has begun. Initial treatment requires vasopressors associated with fluid resuscitation. Steroids are not recommended. Early decompression is recommended for incomplete deficit seen in the first 6 hours. We relate the case of secondary spinal shock to a luxation C6/C7 treated in prehospital care.
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Affiliation(s)
- O Maurin
- Brigade des sapeurs pompiers de Paris, 1 place Jules-Renard, Paris, France.
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