Dedication

Spinal cord injury is a ferocious assault on the body that leaves havoc in its wake. Paralysis is certainly part of its legacy, but there are other equally devastating consequences including autonomic dysfunction compromised cardiovascular, bowel, bladder, and sexual function. Treatments and cures for these losses would greatly improve the quality of life for all of us living with spinal cord injury. I am hopeful that the multi-faceted and collaborative approach to spinal cord repair evidenced...

References

Anderson, C.R. and Edwards, S.L. (1994) Intraperitoneal injections of Fluorogold reliably labels all sympathetic preganglionic neurons in the rat. J. Neurosci. Methods, 53 137-141. Barman, S.M. and Gebber, G.L. (1984) Spinal interneurons with sympathetic nerve-related activity. Am. J. Physiol., 247 R761-R767. Blessing, W.W. (1997) The Lower Brainstem and Bodily Homeostasis. Oxford University Press, New York. Cabot, J.B. (1996) Some principles of the spinal organization of the sympathetic...

Incidence and prevalence of urinary bladder dysfunction after cord injury

Most people, during the first days after spinal cord injury, have evidence of a neurogenic bladder. In people with incomplete injury, the majority of recovery of bladder function is evident in the first 6-9 months and improvement can continue for 2 years after injury. The negative consequences of the neurogenic bladder to the health and quality of life for cord-injured people are decreasing with current improvements in management and understanding of the causes of the problems. In one of the...

List of Contributors

Arenas, Department of Rehabilitation Medicine, University of Miami School of Medicine, P.O. Box 016960 (D-461), Miami, FL 33101, USA K. Anderson, Reeve-Irvine Research Center, 1216 GNRF, University of California, Irvine, Irvine, CA 92697-4292, USA H.W.G. Baker, University of Melbourne Department of Obstetrics and Gynaecology Melbourne IVF Reproductive Services, Royal Women's Hospital, Carlton, Vic. 3058, Australia M.S. Beattie, Department of Neuroscience, laboratory of CNS Repair and Spinal...

Inadequate sphincter function

Inadequate sphincter function, whether associated with inadequate or excessive detrusor function, results in incontinence. Sphincter tone can be enhanced by blocking muscarinic cholinergic receptors or by stimulating b-adrenergic receptors. Of these two possible approaches, blocking mu-scarinic cholinergic receptors is usually the superior, although combination therapy may be utilized. In this condition, the goal is to restore the storage function of the bladder. Once this is accomplished, if...

Foreword

Autonomic dysfunction after spinal cord injury the perspective of a person with a spinal cord injury. Something's wrong. I'm hot. No, wait, now I'm cold. But why am I sweating I never sweat. My legs won't stop jumping. Now my hands are in tight fists and my torso is tight as well. Why does my scalp itch Oh no, the headache is starting. I'm getting dysreflexia What is causing it My catheter seems okay, I don't feel any kinks. But why isn't there any urine in the leg bag Oh no, is the catheter...

Introduction

This book was inspired by a gathering of basic and clinical scientists, and healthcare providers, for a workshop on autonomic dysfunction after spinal cord injury held in Banff, Alberta, Canada in July, 2003. The discussions in this meeting highlighted the contrast between the high priority assigned by people with spinal cord injury to finding a cure for their autonomic dysfunctions, and the limited awareness of these issues or attention given to them by the scientific and medical community,...

Longterm effects

Gradually after spinal cord injury some risks seem to diminish, others persist and new ones develop. By 15-20 years post-injury new complications from the circulatory system are sometimes seen. Following large meals the cord-injured person with a cervical lesion is sometimes unable to sit upright due to rapid fall in blood pressure. Whether this is merely an effect of duration of injury or a marker of concomitant disease is not known. The muscle and skin vascular beds are unable to...

Sexual function

Some cord-injured men already in the intensive care unit ask about their ability to have an active sex life and become fathers. The erectile dysfunction in men after spinal cord injury has different characteristics depending on level of lesion, and mainly follows the pattern of bladder dysfunction. The person with an upper motor neuron lesion usually has the capacity for reflex erection by tactile stimulation. The person with a lower motor neuron lesion has loss of all erectile function. The...

Temperature regulation

The respiratory problems might lead to pneumonia with high fever. Then the cord-injured patient is faced with another effect of autonomic disturbances that is the inability to lose excess heat by sweating. This inability might be life threatening during high fever or in an extremely warm climate. Several years ago a young man was treated at Sa-hlgrenska University Hospital. He had sustained a C4 spinal cord injury and had an aspiration of fluid into his lungs during the transport to hospital....

Contents

List of Foreword by Kim Overview Autonomic dysfunction in spinal cord injury clinical presentation of symptoms and signs A-.K. Karlsson Goteborg, Sweden 1 Section I. Anatomical Changes Mediating Autonomic Dysfunction After Cord Injury 1. Effects of spinal cord injury on synaptic inputs to sympathetic preganglionic neurons I.J. Llewellyn-Smith, L.C. Weaver and J.R. Keast Bedford Park, SA, London, ON, Canada and St. Leonards, NSW, 11 2. Spinal sympathetic interneurons Their identification and...