The isolated sympathetic spinal cord: Cardiovascular and sudomotor assessment in spinal cord injury patients: A literature survey.
OBJECTIVE
To present a comprehensive approach to the assessment of the severity of the autonomic lesion in spinal cord injury (SCI) patients, with regard to the level of lesion. To discuss how to assess an isolated sympathetic spinal cord that has lost supraspinal control (sympathetically complete lesion).


METHODS
PubMed was searched for articles related to cardiovascular (mainly cold pressor test, respiratory and postural challenges) and sudomotor (sympathetic skin responses) tests that have been used. The results of these evaluations are analysed with regard to the site of stimulation (above or below the lesion) according to three types of SCI that offer typical autonomic reactions (tetraplegics, paraplegics at T6 and at T10).


RESULTS
Non-invasive cardiovascular and sudomotor testing allows the assessment of the isolated sympathetic spinal cord in SCI patients. Typical responses are found in relation with the level of the sympathetic lesion. Its definition would allow comparison with the somatic motor and sensory level of lesion of SCI patients and provide additional aid to the classification of those patients.


CONCLUSIONS
For research purposes on the integrity of the spinal sympathetic pathways, a battery of test approach is probably needed, using a combination of stimuli above and below the lesion, evaluating both cardiovascular and sudomotor pathways.
Prévinaire
J G
JG
Département médullaire, centre Calvé, fondation Hopale, 62600 Berck-sur-Mer, France. previnjg@hopale.com
Mathias
C J
CJ
El Masri
W
W
Soler
J-M
JM
Leclercq
V
V
Denys
P
P
D001342:Autonomic Nervous System Diseases / Q000175:diagnosis* / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D010264:Paraplegia / Q000503:physiopathology; D010812:Physical Stimulation / Q000379:methods; D011782:Quadriplegia / Q000503:physiopathology; D012018:Reflex / Q000502:physiology; D012867:Skin / Q000098:blood supply / Q000294:innervation; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*; D013546:Sweating / Q000502:physiology; D013564:Sympathetic Nervous System; D014664:Vasodilation / Q000502:physiology