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Autonomic disturbances in spinal cord lesions 

Autonomic disturbances in spinal cord lesions
Chapter:
Autonomic disturbances in spinal cord lesions
Author(s):

Christopher J. Mathias

, David A. Low

, and Hans L. Frankel

DOI:
10.1093/med/9780198566342.003.0068
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date: 23 October 2021

The integrity of the spinal cord is of particular importance to the normal functioning of the autonomic nervous system, as the entire sympathetic outflow (from Tl to L2/3) and a proportion of the parasympathetic outflow (the sacral parasympathetic) traverse and synapse in the spinal cord before they supply their target organs. In patients with spinal cord injuries (SCI), therefore, there are varying degrees of autonomic involvement, depending upon the site and extent of the lesion. In patients with cervical cord transection, if complete, the entire sympathetic and sacral parasympathetic outflow is separated from cerebral control. This results in a variety of abnormalities affecting the cardiovascular, thermoregulatory, gastrointestinal, urinary, and reproductive systems (Mathias and Low 2011). In patients with transection, which is common after traumatic injuries to the spinal cord, despite destruction of one or more segments, the distal portion of the spinal cord often retains function, although independently of the brain. This results, in certain situations, in additional autonomic abnormalities. In incomplete lesions the functional deficits will vary. This chapter will concentrate on patients with cervical and high SCI, as these patients often have major clinical problems resulting from autonomic dysfunction. The principles apply to other diseases affecting the spinal cord, such as due to syringomyelia or transverse myelitis, with the autonomic impairment depending on the site and extent of the lesion....

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