Vascular dysfunctions following spinal cord injury. 2010

Constantin Popa, and Florian Popa, and Valentin Titus Grigorean, and Gelu Onose, and Aurelia Mihaela Sandu, and Mihai Popescu, and Gheorghe Burnei, and Victor Strambu, and Crina Sinescu
Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

The aim of this article is to analyze the vascular dysfunctions occurring after spinal cord injury (SCI). Vascular dysfunctions are common complications of SCI. Cardiovascular disturbances are the leading causes of morbidity and mortality in both acute and chronic stages of SCI. Neuroanatomy and physiology of autonomic nervous system, sympathetic and parasympathetic, is reviewed. SCI implies disruption of descendent pathways from central centers to spinal sympathetic neurons, originating in intermediolateral nuclei of T1-L2 cord segments. Loss of supraspinal control over sympathetic nervous system results in reduced overall sympathetic activity below the level of injury and unopposed parasympathetic outflow through intact vagal nerve. SCI associates significant vascular dysfunction. Spinal shock occurs during the acute phase following SCI and it is a transitory suspension of function and reflexes below the level of the injury. Neurogenic shock, part of spinal shock, consists of severe arterial hypotension and bradycardia. Autonomic dysreflexia appears during the chronic phase, after spinal shock resolution, and it is a life-threatening syndrome of massive imbalanced reflex sympathetic discharge occurring in patients with SCI above the splanchnic sympathetic outflow (T5-T6). Arterial hypotension with orthostatic hypotension occurs in both acute and chronic phases. The etiology is multifactorial. We described a few factors influencing the orthostatic hypotension occurrence in SCI: sympathetic nervous system dysfunction, low plasma catecholamine levels, rennin-angiotensin-aldosterone activity, peripheral alpha-adrenoceptor hyperresponsiveness, impaired function of baroreceptors, hyponatremia and low plasmatic volume, cardiovascular deconditioning, morphologic changes in sympathetic neurons, plasticity within spinal circuits, and motor deficit leading to loss of skeletal muscle pumping activity. Additional associated cardiovascular concerns in SCI, such as deep vein thrombosis and long-term risk for coronary heart disease and systemic atherosclerosis are also described. Proper prophylaxis, including non-pharmacologic and pharmacological strategies, diminishes the occurrence of the vascular dysfunction following SCI. Each vascular disturbance requires a specific treatment.

UI MeSH Term Description Entries
D007022 Hypotension Abnormally low BLOOD PRESSURE that can result in inadequate blood flow to the brain and other vital organs. Common symptom is DIZZINESS but greater negative impacts on the body occur when there is prolonged depravation of oxygen and nutrients. Blood Pressure, Low,Hypotension, Vascular,Low Blood Pressure,Vascular Hypotension
D012084 Renin-Angiotensin System A BLOOD PRESSURE regulating system of interacting components that include RENIN; ANGIOTENSINOGEN; ANGIOTENSIN CONVERTING ENZYME; ANGIOTENSIN I; ANGIOTENSIN II; and angiotensinase. Renin, an enzyme produced in the kidney, acts on angiotensinogen, an alpha-2 globulin produced by the liver, forming ANGIOTENSIN I. Angiotensin-converting enzyme, contained in the lung, acts on angiotensin I in the plasma converting it to ANGIOTENSIN II, an extremely powerful vasoconstrictor. Angiotensin II causes contraction of the arteriolar and renal VASCULAR SMOOTH MUSCLE, leading to retention of salt and water in the KIDNEY and increased arterial blood pressure. In addition, angiotensin II stimulates the release of ALDOSTERONE from the ADRENAL CORTEX, which in turn also increases salt and water retention in the kidney. Angiotensin-converting enzyme also breaks down BRADYKININ, a powerful vasodilator and component of the KALLIKREIN-KININ SYSTEM. Renin-Angiotensin-Aldosterone System,Renin Angiotensin Aldosterone System,Renin Angiotensin System,System, Renin-Angiotensin,System, Renin-Angiotensin-Aldosterone
D001808 Blood Vessels Any of the tubular vessels conveying the blood (arteries, arterioles, capillaries, venules, and veins). Blood Vessel,Vessel, Blood,Vessels, Blood
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012769 Shock A pathological condition manifested by failure to perfuse or oxygenate vital organs. Circulatory Collapse,Circulatory Failure,Hypovolemic Shock,Collapse, Circulatory,Failure, Circulatory,Shock, Hypovolemic
D013116 Spinal Cord A cylindrical column of tissue that lies within the vertebral canal. It is composed of WHITE MATTER and GRAY MATTER. Coccygeal Cord,Conus Medullaris,Conus Terminalis,Lumbar Cord,Medulla Spinalis,Myelon,Sacral Cord,Thoracic Cord,Coccygeal Cords,Conus Medullari,Conus Terminali,Cord, Coccygeal,Cord, Lumbar,Cord, Sacral,Cord, Spinal,Cord, Thoracic,Cords, Coccygeal,Cords, Lumbar,Cords, Sacral,Cords, Spinal,Cords, Thoracic,Lumbar Cords,Medulla Spinali,Medullari, Conus,Medullaris, Conus,Myelons,Sacral Cords,Spinal Cords,Spinali, Medulla,Spinalis, Medulla,Terminali, Conus,Terminalis, Conus,Thoracic Cords
D013119 Spinal Cord Injuries Penetrating and non-penetrating injuries to the spinal cord resulting from traumatic external forces (e.g., WOUNDS, GUNSHOT; WHIPLASH INJURIES; etc.). Myelopathy, Traumatic,Injuries, Spinal Cord,Post-Traumatic Myelopathy,Spinal Cord Contusion,Spinal Cord Laceration,Spinal Cord Transection,Spinal Cord Trauma,Contusion, Spinal Cord,Contusions, Spinal Cord,Cord Contusion, Spinal,Cord Contusions, Spinal,Cord Injuries, Spinal,Cord Injury, Spinal,Cord Laceration, Spinal,Cord Lacerations, Spinal,Cord Transection, Spinal,Cord Transections, Spinal,Cord Trauma, Spinal,Cord Traumas, Spinal,Injury, Spinal Cord,Laceration, Spinal Cord,Lacerations, Spinal Cord,Myelopathies, Post-Traumatic,Myelopathies, Traumatic,Myelopathy, Post-Traumatic,Post Traumatic Myelopathy,Post-Traumatic Myelopathies,Spinal Cord Contusions,Spinal Cord Injury,Spinal Cord Lacerations,Spinal Cord Transections,Spinal Cord Traumas,Transection, Spinal Cord,Transections, Spinal Cord,Trauma, Spinal Cord,Traumas, Spinal Cord,Traumatic Myelopathies,Traumatic Myelopathy
D014652 Vascular Diseases Pathological processes involving any of the BLOOD VESSELS in the cardiac or peripheral circulation. They include diseases of ARTERIES; VEINS; and rest of the vasculature system in the body. Disease, Vascular,Diseases, Vascular,Vascular Disease
D020211 Autonomic Dysreflexia A syndrome associated with damage to the spinal cord above the mid thoracic level (see SPINAL CORD INJURIES) characterized by a marked increase in the sympathetic response to minor stimuli such as bladder or rectal distention. Manifestations include HYPERTENSION; TACHYCARDIA (or reflex bradycardia); FEVER; FLUSHING; and HYPERHIDROSIS. Extreme hypertension may be associated with a STROKE. (From Adams et al., Principles of Neurology, 6th ed, pp538 and 1232; J Spinal Cord Med 1997;20(3):355-60) Autonomic Hyperreflexia,Dysreflexia, Autonomic,Hyperreflexia, Autonomic,Spinal Autonomic Dysreflexia,Autonomic Dysreflexia, Spinal,Autonomic Dysreflexias,Autonomic Dysreflexias, Spinal,Autonomic Hyperreflexias,Dysreflexia, Spinal Autonomic,Dysreflexias, Autonomic,Dysreflexias, Spinal Autonomic,Hyperreflexias, Autonomic,Spinal Autonomic Dysreflexias

Related Publications

Constantin Popa, and Florian Popa, and Valentin Titus Grigorean, and Gelu Onose, and Aurelia Mihaela Sandu, and Mihai Popescu, and Gheorghe Burnei, and Victor Strambu, and Crina Sinescu
January 1990, Annals of the New York Academy of Sciences,
Constantin Popa, and Florian Popa, and Valentin Titus Grigorean, and Gelu Onose, and Aurelia Mihaela Sandu, and Mihai Popescu, and Gheorghe Burnei, and Victor Strambu, and Crina Sinescu
July 1991, The Journal of the American Paraplegia Society,
Constantin Popa, and Florian Popa, and Valentin Titus Grigorean, and Gelu Onose, and Aurelia Mihaela Sandu, and Mihai Popescu, and Gheorghe Burnei, and Victor Strambu, and Crina Sinescu
July 2020, Neurogastroenterology and motility,
Constantin Popa, and Florian Popa, and Valentin Titus Grigorean, and Gelu Onose, and Aurelia Mihaela Sandu, and Mihai Popescu, and Gheorghe Burnei, and Victor Strambu, and Crina Sinescu
June 2015, Clinical neurology and neurosurgery,
Constantin Popa, and Florian Popa, and Valentin Titus Grigorean, and Gelu Onose, and Aurelia Mihaela Sandu, and Mihai Popescu, and Gheorghe Burnei, and Victor Strambu, and Crina Sinescu
March 2014, Journal of neurotrauma,
Constantin Popa, and Florian Popa, and Valentin Titus Grigorean, and Gelu Onose, and Aurelia Mihaela Sandu, and Mihai Popescu, and Gheorghe Burnei, and Victor Strambu, and Crina Sinescu
October 1975, Clinical orthopaedics and related research,
Constantin Popa, and Florian Popa, and Valentin Titus Grigorean, and Gelu Onose, and Aurelia Mihaela Sandu, and Mihai Popescu, and Gheorghe Burnei, and Victor Strambu, and Crina Sinescu
December 1961, Medical record and annals,
Constantin Popa, and Florian Popa, and Valentin Titus Grigorean, and Gelu Onose, and Aurelia Mihaela Sandu, and Mihai Popescu, and Gheorghe Burnei, and Victor Strambu, and Crina Sinescu
April 2012, Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke,
Constantin Popa, and Florian Popa, and Valentin Titus Grigorean, and Gelu Onose, and Aurelia Mihaela Sandu, and Mihai Popescu, and Gheorghe Burnei, and Victor Strambu, and Crina Sinescu
May 1991, The Western journal of medicine,
Constantin Popa, and Florian Popa, and Valentin Titus Grigorean, and Gelu Onose, and Aurelia Mihaela Sandu, and Mihai Popescu, and Gheorghe Burnei, and Victor Strambu, and Crina Sinescu
May 1998, Spinal cord,
Copied contents to your clipboard!