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AUTONOMIC HYPERREFLEXIA AND ITS CONTROL IN PATIENTS WITH SPINAL CORD LESIONS

1956; American College of Physicians; Volume: 44; Issue: 4 Linguagem: Inglês

10.7326/0003-4819-44-4-678

1539-3704

N B KURNICK,

Spinal Dysraphism and Malformations

Article1 April 1956AUTONOMIC HYPERREFLEXIA AND ITS CONTROL IN PATIENTS WITH SPINAL CORD LESIONSN. B. KURNICK, M.D.N. B. KURNICK, M.D.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-44-4-678 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptINTRODUCTIONSomatic hyperreflexia following interruption by spinal cord lesions of inhibitory impulses from higher centers is well known. There is, perhaps, less awareness of the analogous autonomic hyperreflexia.1-6 Since the major splanchnic outflow in this system is from the T4 or T6 to L2 segments of the cord, dramatic dysfunction of the autonomic system is seen primarily following lesions above this level, i.e., high thoracic and cervical cord lesions. At least 85% of quadriplegic patients develop autonomic hyperreflexia characterized by paroxysmal hypertension (Bors, personal communication).A diagrammatic sketch of the tracts concerned is shown in figure 1. Afferent pathways are...Bibliography1. BorsFrench EJD: Management of paroxysmal hypertension following injuries to cervical and upper thoracic segments of the spinal cord, Arch. Surg. 64: 803-812, 1952. CrossrefGoogle Scholar2. HeadRiddoch HJ: The automatic bladder, excessive sweating and some other reflex conditions in gross injuries of the spinal cord, Brain 40: 188-263, 1917. CrossrefGoogle Scholar3. GuttmannWhitteridge LD: Effects of bladder distention on autonomic mechanism after spinal cord injuries, Brain 70: 361-405, 1947. CrossrefMedlineGoogle Scholar4. ThompsonWitham CEAC: Paroxysmal hypertension in spinal cord injuries, New England J. Med. 239: 291-294, 1948. CrossrefMedlineGoogle Scholar5. PollockBoshesChorFinkelmanArieffBrown LJBHIAJM: Defects in regulatory mechanisms of autonomic function in injuries to spinal cord, J. Neurophysiol. 14: 85-94, 1951. CrossrefMedlineGoogle Scholar6. SchumacherGuthrie GATC: Studies on headache: mechanisms of headache and observations in other effects induced by distention of bladder and rectum in subjects with spinal cord injuries, Arch. Neurol. and Psychiat. 65: 568-580, 1951. CrossrefGoogle Scholar7. Smirk FH: Blood pressure reduction in arterial hypertension by hexamethonium and pentapyrrolidinium salts, Am. J. Med. 17: 839-850, 1954. CrossrefMedlineGoogle Scholar8. Wolff HG: The mechanisms and significance of the cold pressor response, Quart. J. Med. 20: 261-273, 1951. MedlineGoogle Scholar9. HughesMoyerDaeschner WMJHWC: Parenteral reserpine in treatment of hypertensive emergencies, Arch. Int. Med. 95: 563-577, 1955. CrossrefGoogle Scholar10. BorsComarrMoulton EAESH: The role of nerve blocks in management of traumatic cord bladders: spinal anesthesia, subarachnoid alcohol injections, pudendal nerve anesthesia and vesical neck anesthesia, J. Urol. 63: 653-666, 1950. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Long Beach, California*Received for publication September 14, 1955. (The material in this paper has been presented at the American Federation for Clinical Research meeting in Atlantic City, May, 1955. An abstract is published in Clin. Res. Proc. 3: 143-144, 1955.)From the Research Laboratory, Paraplegia Service, Veterans Administration Hospital, Long Beach, California, and the Department of Medicine, University of California Medical Center, Los Angeles, California. Aided by a grant from the Life Insurance Medical Research Fund. 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