Changes in Body Temperature in Incomplete Spinal Cord Injury by Digital Infrared Thermographic Imaging

Fever as a rare combined symptom of degenerative cervical myelopathy: a case report and literature review

A 60-year-old male patient complained of weakness of both legs for one year, intermittent fever for two months, up to 38.0 °C. Physical examination showed bilateral hyperreflexia of knee tendon and positive Hoffman sign on the right side. MR imaging of the cervical spine showed central herniation of the cervical 5-7 disc and compression of the spinal cord. The WBC was normal, C-reactive protein was 24.42mg/l, ESR was 55mm/h, TB antibody, anti acid staining and T-SPOT were negative. Autoantibody was negative and thyroid function was normal. The JOA score was 9 points. During the operation, the herniated disc tissue was taken out for pathological examination and bacterial culture. The posterior longitudinal ligament was removed and no abscess was found. The symptom of asthenia in both legs was relieved and fever disappeared. No growth of aerobe, anaerobe or tubercle bacilli was found in the culture of resected tissue. One year after the operation, the fever did not recur, JOA score increased to 14 points, and MR imaging showed no protrusion in cervical spinal canal. In this case, the fever disappeared after the operation for cervical spondylosis, which may be a special manifestation of sympathetic nerve stimulation or autonomic dysfunction by chronic compression of spinal cord.

Recurrent Regional Autonomic Dysfunction as a Presentation of Relapsing Neuromyelitis Optica Spectrum Disorder, Responsive to Ketamine Infusion

Diagnostic criteria of neuromyelitis optica spectrum disorders (NMOSD) have expanded to include many new symptoms since the original description of Devic's disease in 1894, and the formulation of diagnostic criteria in 2006. Herein, we describe a patient with serum aquaporin positive NMOSD with the unusual presentation of recurrent regional autonomic dysfunction, with concordant MRI findings. The symptomatic treatment of the patient's causalgia required IV ketamine infusion. Besides, as the long segment myelitis occurred in the setting of extensively drug-resistant tuberculosis (XDR TB), there was the added challenge of ruling out TB myelitis and choosing an immunosuppressant that would have the least risk of reactivation of TB.

Altered Core Temperature and Salivary Melatonin in Athletes with a Cervical Spinal Cord Injury

Sleep disturbances are common in athletes with a cervical spinal cord injury (cSCI) and may be associated with circadian alterations. Therefore, the purpose of this study was to compare physiological circadian outputs between athletes with a cSCI and non-disabled controls (CON). Eight male wheelchair athletes with a cSCI and eight male CON (30±4 and 30±6 yrs, respectively) had their core body temperature (T_core), skin temperature (T_skin), and salivary melatonin measured during a 24 h period. In the cSCI group, daytime T_core was significantly lower (36.5 (0.2) vs 36.9 (0.3)°C; p=0.02) and time of the T_core sleep minimum was significantly earlier (23:56±00:46 vs 02:39 ± 02:57; p=0.04). The athletes with a cSCI had significantly lower T_core values during the beginning of the night compared with the CON group, but their T_core increased at a greater rate, thereafter, indicated by a significant time/group interaction (p=0.04). Moreover, the cSCI group did not display a salivary melatonin response and exhibited significantly lower concentrations at 22:00 (p=0.01) and 07:00 (p=0.01) compared with the CON group. Under natural living conditions, athletes with a cSCI displayed circadian changes in the T_core rhythm and nocturnal melatonin production.

Skeletal muscle stiffness as measured by magnetic resonance elastography after chronic spinal cord injury: a cross-sectional pilot study

Skeletal muscle stiffness is altered after spinal cord injury (SCI). Assessing muscle stiffness is essential for rehabilitation and pharmaceutical interventions design after SCI. The study used magnetic resonance elastography to assess the changes in stiffness after chronic SCI compared to matched able-bodied controls and determine its association with muscle size, spasticity, and peak torque in persons with SCI. Previous studies examined the association between muscle stiffness and spasticity, however, we are unaware of other studies that examined the effects of muscle composition on stiffness after SCI. Ten participants (one female) with chronic SCI and eight (one female) matched able-bodied controls participated in this cross-sectional study. Magnetic resonance elastography was utilized to monitor stiffness derived from shear waves propagation. Modified Ashworth scale was used to evaluate spasticity scores in a blinded fashion. Peak isometric and isokinetic torques were measured using a biodex dynamometer. Stiffness values were non-significantly lower (12.5%; P = 0.3) in the SCI group compared to able-bodied controls. Moreover, stiffness was positively related to vastus lateralis whole muscle cross-sectional area (CSA) (r² = 0.64, P < 0.005) and vastus lateralis absolute muscle CSA after accounting for intramuscular fat (r² = 0.78, P < 0.0007). Stiffness was also positively correlated to both isometric (r²= 0.55-0.57, P < 0.05) and isokinetic peak (r²= 0.46-0.48, P < 0.05) torques. Our results suggest that larger clinical trial is warranted to confirm the preliminary findings that muscle stiffness is altered after SCI compared to healthy controls. Stiffness appeared to be influenced by infiltration of intramuscular fat and modestly by the spasticity of the paralyzed muscles. The preliminary data indicated that the relationship between muscle stiffness and peak torque is not altered with changing the frequency of pulses or angular velocities. All study procedures were approved by the Institutional Review Board at the Hunter Holmes McGuire VA Medical Center, USA (IRB #: 02314) on May 3, 2017.

Experimental study on the effectiveness of the PCM cooling vest in persons with paraplegia of varying levels

Persons with paraplegia (PA) from thoracic spinal cord injury (T1-T12) are prone to thermal stress during exercise due to impaired thermoregulation. This study evaluates the effectiveness of phase change material (PCM) cooling vests on persons with PA of different levels of injury during exercise in hot exposure. Sixteen participants were recruited and divided to three groups based on injury level; high-thoracic T1-T3, mid-thoracic T4-T8, and low thoracic T9-T12 to perform a 30-min arm-crank exercise at a 30 °C room condition. Two types of PCM vests at melting temperature of 20 °C were tested: i) V1 with PCM covering the trunk of 3.4 kg overall vest mass and ii) V2 with PCM covering chest and upper back of 2.17 kg overall vest mass. High thoracic and low-thoracic groups performed NV and V1 tests; whereas, mid-thoracic group performed NV, V1, and V2 tests. Heart rate, core, and skin temperatures were monitored during 15-min preconditioning, 30-min exercise, and 15-min recovery. In addition, thermal comfort, sensation, skin wettedness, and perceived exertion were recorded during exercise only. The main findings were that the effectiveness of the cooling vest was dependent on injury level and portion of sensate skin of trunk covered by the PCM packets. Rise in core temperature (ΔT_cr) was reduced significantly for the low-thoracic group during exercise and recovery (ΔT_cr=0.41°C, 0.26°C for NV and V1; respectively, p<0.05). For the mid-thoracic group, both V1 (p = 0.001) and V2 (p = 0.008) were effective in reducing ΔT_cr compared to the NV test at the end of the recovery period (0.74°C,0.42°C,0.56°C, for NV, V1 and V2; respectively). For the high-thoracic group, V1 was not effective in reducing core temperature (p>0.05). For the mid-thoracic group, V2 at 36% lower mass significantly improved thermal comfort (p = 0.0004) compared to the NV test and was as effective compared to V1 in reducing core temperature.

The relationship between the severity of coronary artery disease and skin measurement parameters

PURPOSE

This study aimed to investigate the relationship between skin parameters and CAD.

MATERIALS AND METHODS

The study included 50 patients diagnosed with coronary artery disease as the patient group and 45 volunteers without any known coronary artery disease as the control group. The participants' skin TEWL, pH, temperature, electrical capacitance, sebum, and elasticity values were measured using noninvasive methods at the forehead, back, and forearm.

FINDINGS

Skin temperature was significantly higher in the back and forehead regions in the patient group. No difference was found between the sebum values of the patient and control groups at the back and forehead. A significantly higher result was obtained for the forearm area. The pH was significantly lower in the patients' forearm, although the obtained values were within the normal range. The TEWL was significantly higher in patients in all three regions. In terms of flexibility, R2 was significantly higher in the back and forehead regions of the patient group, and the R6 was significantly higher in the patient group in all three regions. In addition, there was no correlation between skin parameter and SYNTAX score increase measurements.

CONCLUSION

It can be suggested that skin sebum and TEWL measurements can be accepted as cheap and noninvasive methods of predicting CAD.

Evaporative heat loss insufficient to attain heat balance at rest in individuals with a spinal cord injury at high ambient temperature

The aim of the study was to determine whether climatic limits for achieving heat balance at rest are affected by spinal cord injury (SCI). Twenty-three men [8 able-bodied (AB), 8 with paraplegia (PP), and 7 with tetraplegia (TP)] rested in 37°C and 20% relative humidity (RH) for 20 min. With the ambient temperature held constant, RH was increased by 5% every 7 min, until gastrointestinal temperature (Tgi) showed a clear inflection or increased by >1°C. Tgi, skin temperatures, perceptual responses, and metabolic energy expenditure were measured throughout. Metabolic heat production [AB: 123 (21) W, PP: 111 (15) W, TP: 103 (29) W; means (SD)] and required rate of evaporative cooling for heat balance [Ereq; AB: 113 (20) W, PP: 107 (17) W, TP: 106 (29) W] were similar between groups ( P = 0.22 and P = 0.79). Compared with AB, greater increases in Tgi were observed in TP ( P = 0.01), with notable increases in mean skin temperature (Tsk) for TP and PP ( P = 0.01). A Tgi inflection point was demonstrated by seven AB, only three of eight PP, and no TP. Despite metabolic heat production (and Ereq) being similar between groups, evaporative heat loss was not large enough to obtain heat balance in TP, linked to a shortfall in evaporative cooling potential. Although PP possess a greater sweating capacity, the continual increase in Tgi and Tsk in most PP, although lower than for TP, implies that latent heat loss for PP is also insufficient to attain heat balance.

NEW & NOTEWORTHY In the absence of convective heat loss, at temperatures around 37°C evaporative heat loss is insufficient to attain heat balance at rest in individuals with paraplegia and tetraplegia. This finding was directly linked to a shortfall in evaporative cooling potential compared with required evaporative cooling. In this environment, individuals with both paraplegia and tetraplegia cannot subjectively determine the magnitude of their thermal strain; thus perceptual responses should not be relied upon for this population group.

Impact of passive heat stress on persons with spinal cord injury: Implications for Olympic spectators

Environmental heat stress can negatively impact health, work capacity, and athletic performance and potentially to lead to life-threatening consequences if not mitigated. With the upcoming Toyko Olympic games to be held during anticipated warm ambient temperatures (up to 29°C), and with spectators potentially spending long durations of time outdoors, certain populations of persons with impaired thermoregulatory capacity will be at higher risk of heat-related illness from passive heat stress. Persons with spinal cord injury (SCI) are one of these groups as a result of a decentralized sympathetic nervous system, which leaves them with impairment in convective and evaporative cooling via vasodilation and sweating, respectively. This review summarizes (1) thermoregulatory physiological responses of persons with SCI under passive heat stress: the effect of level and completeness of injury; (2) the impact of passive heat stress on quality of life (QOL), outdoor participation, behavioral thermoregulation, and cognition; (3) recommendations and education for clinicians providing health care for persons with SCI; and (4) suggestions of future directions for exploring the gaps in the literature on passive heat stress in persons with SCI. This article aims to equip consumers with SCI and health-care professionals with the most up-to-date knowledge on passive heat stress responses in persons with SCI, so that their attendance at the Olympic games can be done with maximal safety and enjoyment.

Comparison between esophageal and intestinal temperature responses to upper-limb exercise in individuals with spinal cord injury

STUDY DESIGN

Experimental study.

OBJECTIVE

Individuals with spinal cord injuries (SCI) may present with impaired sympathetic control over thermoregulatory responses to environmental and exercise stressors, which can impact regional core temperature (T_core) measurement. The purpose of this study was to investigate whether regional differences in T_core responses exist during exercise in individuals with SCI.

SETTING

Rehabilitation centre in Wakayama, Japan.

METHODS

We recruited 12 men with motor-complete SCI (7 tetraplegia, 5 paraplegia) and 5 able-bodied controls to complete a 30-min bout of arm-cycling exercise at 50% V̇O₂ peak reserve. T_core was estimated using telemetric pills (intestinal temperature; T_int) and esophageal probes (T_eso). Heat storage was calculated from baseline to 15 and 30 min of exercise.

RESULTS

At 15 min of exercise, elevations in T_eso (Δ0.39 ± 0.22 °C; P < 0.05), but not T_int (Δ0.04 ± 0.18 °C; P = 0.09), were observed in able-bodied men. At 30 min of exercise, men with paraplegia and able-bodied men both exhibited increases in T_eso (paraplegia: Δ0.56 ± 0.30 °C, P < 0.05; able-bodied men: Δ0.60 ± 0.31 °C, P < 0.05) and T_int (paraplegia: Δ0.38 ± 0.33 °C, P < 0.05; able-bodied men: Δ0.30 ± 0.30 °C, P < 0.05). T_eso began rising 7.2 min earlier than T_int (pooled, P < 0.01). Heat storage estimated by T_eso was greater than heat storage estimated by T_int at 15 min (P = 0.02) and 30 min (P = 0.03) in men with paraplegia. No elevations in T_eso, T_int, or heat storage were observed in men with tetraplegia.

CONCLUSIONS

While not interchangeable, both T_eso and T_int are sensitive to elevations in T_core during arm-cycling exercise in men with paraplegia, although T_eso may have superior sensitivity to capture temperature information earlier during exercise.

Short- and long-term reproducibility of diffusion-weighted magnetic resonance imaging of lower extremity musculature in asymptomatic individuals and a comparison to individuals with spinal cord injury

Background

Diffusion-weighted magnetic resonance imaging (DW-MRI) of skeletal muscle has the potential to be a sensitive diagnostic and/or prognostic tool in complex, enigmatic neuromusculoskeletal conditions such as spinal cord injury and whiplash associated disorder. However, the reliability and reproducibility of clinically accessible DW-MRI parameters in skeletal muscle remains incompletely characterized – even in individuals without neuromusculoskeletal injury – and these parameters have yet to be characterized for many clinical populations. Here, we provide normative measures of the apparent diffusion coefficient (ADC) in healthy muscles of the lower limb; assess the rater-based reliability and short- and long-term reproducibility of the ADC in the same muscles; and quantify ADC of these muscles in individuals with motor incomplete spinal cord injury.

Methods

Twenty individuals without neuromusculoskeletal injury and 14 individuals with motor incomplete spinal cord injury (SCI) participated in this investigation. We acquired bilateral diffusion-weighted MRI of the lower limb musculature in all participants at 3 T using a multi-shot echo-planar imaging sequence with b-values of 0, 100, 300 and 500 s/mm² and diffusion-probing gradients applied in 3 orthogonal directions. Outcome measures included: (1) average ADC in the lateral and medial gastrocnemius, tibialis anterior, and soleus of individuals without neurological or musculoskeletal injury; (2) intra- and inter-rater reliability, as well as short and long-term reproducibility of the ADC; and (3) estimation of average muscle ADC in individuals with SCI.

Results

Intra- and inter-rater reliability of the ADC averaged 0.89 and 0.79, respectively, across muscles. Least significant change, a measure of temporal reproducibility, was 4.50 and 11.98% for short (same day) and long (9-month) inter-scan intervals, respectively. Average ADC was significantly elevated across muscles in individuals with SCI compared to individuals without neurological or musculoskeletal injury (1.655 vs. 1.615 mm²/s, respectively).

Conclusions

These findings provide a foundation for future studies that track longitudinal changes in skeletal muscle ADC of the lower extremity and/or investigate the mechanisms underlying ADC changes in cases of known or suspected pathology.

An Optical Fiber-Based Data-Driven Method for Human Skin Temperature 3-D Mapping

Human skin temperature mapping provides abundant information of physiological conditions of human body, which provides supplementary or alternative indicators for disease monitoring or diagnosis. The existing models of temperature mapping or temperature field distribution of human skin are generally established by finite element method. Due to the complexity of biological systems, it is challenging to achieve high accuracy mathematical models of temperature field of human skin. The goal of this study is to establish human skin temperature three-dimensional (3-D) mapping platform by integrating optical fibers and improved genetic algorithm-back propagation (GA-BP) neural network. The proposed data-driven method is capable of acquiring entire human skin temperature 3-D mapping by simply measuring a few points on human skin. Multiple experiments were conducted to validate the proposed method on different areas of human skin in different ambient environments. In each experiment setting, the measured data and the model output data were compared. The mean absolute error in all the validation experiments is 0.11 °C, which is lower than that in the state of the art using physical modeling for skin temperature prediction and more close to clinical accuracy. The results show that the proposed approach is accurate and reliable, which may provide a platform technology for human skin temperature mapping that can be used in both medical and scientific studies as well as home monitoring.

Thermoregulation following spinal cord injury

Spinal cord injury results in physiologic adaptations affecting heat production (reduced muscle mass) and heat dissipation (blood redistribution and reduced sweating capacity below the level of lesion). However, it is the balance between these factors which determines whether heat balance is achieved. Core temperature estimates are generally consistent with those for the able-bodied, with cooler values reported in some instances. More notable differences are demonstrated through cooler lower-body skin temperatures at rest and a loss of anticipatory control during exposure to heat and cold when compared to the able-bodied. During exercise in cool conditions persons with paraplegia demonstrate similar body temperature responses as for the able-bodied but retain heat during recovery. Persons with tetraplegia demonstrate continual increases in core temperature and thus thermal imbalance along with greater heat retention. During exercise in the heat, athletes with paraplegia appear to be able to regulate body temperature to a similar extent as the able-bodied. Those with tetraplegia again show thermal imbalance but to a much greater extent than in the cold. Future work should focus upon specific sweating responses and adaptations following spinal cord injury, the effects of completeness of lesion, perceptual responses to environmental challenges, and how these translate to undertaking activities of daily living.

Hypothermia with Extreme Bradycardia following Spinal Cord Infarction of Septic Origin

Among other autonomic dysfunctions complicating acute spinal cord injury, deep hypothermia is rare but may induce serious cardiovascular complications. There are few pharmacological options to influence hypothermia. A 66-year-old woman was transferred to the intensive care unit (ICU) for serious cardiac arrhythmias (atrial fibrillation and asystole) in the context of a deep hypothermia (axillary temperature below 32°C). She had been admitted to the hospital two months before for an acute L4-L5 infectious spondylodiscitis without any initial neurological deficit. After surgery for epidural abscess drainage, she became paraplegic due to spinal cord infarction (from C7 to T6 levels) in the upper territory of the anterior spinal artery. In the ICU, the patient experienced several episodes of asystole and hypotension associated with a core body temperature below 35°C. Common causes of hypothermia (drugs, hypothyroidism, etc.) were excluded. A definitive pacemaker had to be inserted, but hypotension persisted. The prescription of oral progesterone (200 mg·d⁻¹) helped to maintain a core temperature higher than 35°C, with a withdrawal of vasopressors. This case report illustrates that patients with incomplete spinal cord injury may present with delayed and deep hypothermia leading to serious cardiovascular complications. Progesterone could be able to influence positively central and peripheral thermal regulation.

Contributors to Metabolic Disease Risk Following Spinal Cord Injury

Spinal cord injury (SCI) induced changes in neurological function have significant impact on the metabolism and subsequent metabolic-related disease risk in injured individuals. This metabolic-related disease risk relationship is differential depending on the anatomic level and severity of the injury, with high level anatomic injuries contributing a greater risk of glucose and lipid dysregulation resulting in type 2 diabetes and cardiovascular disease risk elevation. Although alterations in body composition, particularly excess adiposity and its anatomical distribution in the visceral depot or ectopic location in non-adipose organs, is known to significantly contribute to metabolic disease risk, changes in fat mass and fat-free mass do not fully account for this elevated disease risk in subjects with SCI. There are other negative adaptations in body composition including reductions in skeletal muscle mass and alterations in muscle fiber type, in addition to significant reduction in physical activity, that contribute to a decline in metabolic rate and increased metabolic disease risk following SCI. Recent studies in adult humans suggest cold- and diet-induced thermogenesis through brown adipose tissue metabolism may be important for energy balance and substrate metabolism, and particularly sensitive to sympathetic nervous signaling. Considering the alterations that occur in the autonomic nervous system (SNS) (sympathetic and parasympathetic) following a SCI, significant dysfunction of brown adipose function is expected. This review will highlight metabolic alterations following SCI and integrate findings from brown adipose tissue studies as potential new areas of research to pursue.