Autonomic Dysfunction in Spinal Cord Disease

Abstract

Cortical, hypothalamic and brainstem projections directly or indirectly influence autonomic centres in the intermediolateral cell columns of the T1 to L2 or L3 cord segments with both inhibitory and facilitatory inputs to the sympathetic centres and the S2 to S4 sacral parasympathetic centres. Vagal afferent and efferent projections from the nuclei of the tractus solitarius and ambiguus in the medulla are not directly involved by spinal cord disease whereas sympathoexcitatory neurones of the rostral ventrolateral medulla are partially or completely prevented from reaching their target neurones in the intermediolateral cell columns. This relative absence of sympathetic activation may lead to a relative overactivity of vagal activity especially if the functional disconnection is relatively acute and complete; an example is the occurrence of profound bradycardia and cardiac arrest with tracheal suction in the recently injured quadraplegic.