Autonomic Nervous System and Spinal Cord Injury: Difference between revisions

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== ANS and Spinal Cord Injury (SCI) ==
== ANS and Spinal Cord Injury (SCI) ==
After a spinal cord injury, all three subsystems of the autonomic nervous system are affected due to their anatomical location, loss of supraspinal influence, and sustained responses to afferent stimuli.<ref name=":0">Henke AM, Billington ZJ, Gater DR Jr. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9320320/pdf/jpm-12-01110.pdf Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review.] J Pers Med. 2022 Jul 7;12(7):1110.</ref> The pathophysiological responses from the ANS can be as follows:
After a spinal cord injury, all three subsystems of the autonomic nervous system are affected due to their anatomical location, loss of supraspinal influence, and sustained responses to afferent stimuli.<ref name=":0">Henke AM, Billington ZJ, Gater DR Jr. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9320320/pdf/jpm-12-01110.pdf Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review.] J Pers Med. 2022 Jul 7;12(7):1110.</ref> The pathophysiological responses from the ANS that contribute to the comorbidities and mortality of SCI include the following systems:<ref name=":0" /><ref>Harding M. Autonomic Nervous System and Spinal Cord Injury. Plus Course 2024</ref>


pinal cord injury (SCI) influences all three components of the ANS due to their relative anatomical locations, loss of supraspinal influence and unabated responses to afferent stimuli, resulting in pathophysiological responses in the cardiovascular, thermoregulatory, respiratory, gastrointestinal, and genitourinary systems that contribute to the comorbidities and mortality of SCI"<ref name=":0" />
* Cardiovascular due to parasympathetic dominance with weakening influence of the sympathetic nervous system in cervical and high thoracic levels of spinal cord injury  
** Low resting arterial blood pressure
** Postural hypotension
** Autonomic dysreflexia (Acute hypertension)
** Bradycardia or arrhythmia
* Thermoregulatory
** Poikilothermia
*** Absorbing an encompassing temperature as a result of inability to regulate core body temperature
** Quad fever (idiopathic hyperpyrexia)
** Exercise-induced fever
** Hyperhidrosis or hypohidrosis
* Respiratory
** Bronchiolar constriction,  
** Hyper-reactive airways
** Increased mucus secretion
* Gastrointestinal
** Acute and chronic increased in gastric acid secretions
** High rates of biliary sludge, cholelithiasis and cholecystitis
** Increased transit time at the distal colon
** Reflex colorectal contractions
*** Constipation or bowel incontinence
* Genitourinary
** Bladder and bowel dysfunction
** Sexual function affecting arousal, ejaculation, and orgasm
** Problems during pregnancy, labour, and breastfeeding


Firstly, blood pressure: during spinal or neurogenic shock, low resting arterial blood pressure with postural hypotension. And thirdly, with autonomic dysreflexia in the less acute stage. Then heart rate: bradycardia or arrhythmias. Thermoregulation, including poikilothermia; quad fever; which is a idiopathic hyperpyrexia; and exercise-induced fever. Sweating: either hyperhidrosis or hypohidrosis. Bladder and bowel function or dysfunction. Sexual function affecting arousal, ejaculation, and orgasm. Pregnancy, labour, and breastfeeding can be affected. And other procedures, such as functional electrical stimulation, surgery, invasive investigational procedures such as urodynamic studies. And then also during pain or injury: stretches, fractures, or UTIs.  
 
And other procedures, such as functional electrical stimulation, surgery, invasive investigational procedures such as urodynamic studies. And then also during pain or injury: stretches, fractures, or UTIs.


== Assessment of ANS in SCI ==
== Assessment of ANS in SCI ==

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Introduction[edit | edit source]

Anatomy of the Autonomic Nervous System (ANS)[edit | edit source]

There are two main functions of the autonomic nervous system:

  • regulating visceral functions
  • maintaining homeostasis within the human body

Sympathetic Nervous System (SNS)[edit | edit source]

Parasympathetic Nervous System (PNS)[edit | edit source]

Enteric Nervous System (ENS)[edit | edit source]

ANS and Spinal Cord Injury (SCI)[edit | edit source]

After a spinal cord injury, all three subsystems of the autonomic nervous system are affected due to their anatomical location, loss of supraspinal influence, and sustained responses to afferent stimuli.[1] The pathophysiological responses from the ANS that contribute to the comorbidities and mortality of SCI include the following systems:[1][2]

  • Cardiovascular due to parasympathetic dominance with weakening influence of the sympathetic nervous system in cervical and high thoracic levels of spinal cord injury
    • Low resting arterial blood pressure
    • Postural hypotension
    • Autonomic dysreflexia (Acute hypertension)
    • Bradycardia or arrhythmia
  • Thermoregulatory
    • Poikilothermia
      • Absorbing an encompassing temperature as a result of inability to regulate core body temperature
    • Quad fever (idiopathic hyperpyrexia)
    • Exercise-induced fever
    • Hyperhidrosis or hypohidrosis
  • Respiratory
    • Bronchiolar constriction,
    • Hyper-reactive airways
    • Increased mucus secretion
  • Gastrointestinal
    • Acute and chronic increased in gastric acid secretions
    • High rates of biliary sludge, cholelithiasis and cholecystitis
    • Increased transit time at the distal colon
    • Reflex colorectal contractions
      • Constipation or bowel incontinence
  • Genitourinary
    • Bladder and bowel dysfunction
    • Sexual function affecting arousal, ejaculation, and orgasm
    • Problems during pregnancy, labour, and breastfeeding


And other procedures, such as functional electrical stimulation, surgery, invasive investigational procedures such as urodynamic studies. And then also during pain or injury: stretches, fractures, or UTIs.

Assessment of ANS in SCI[edit | edit source]

Function of the ANS in SCI[edit | edit source]

Resources[edit | edit source]

  • bulleted list
  • x

or

  1. numbered list
  2. x

References[edit | edit source]

  1. ↑ 1.0 1.1 Henke AM, Billington ZJ, Gater DR Jr. Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review. J Pers Med. 2022 Jul 7;12(7):1110.
  2. ↑ Harding M. Autonomic Nervous System and Spinal Cord Injury. Plus Course 2024
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