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Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury
Autonomic dysreflexia (AD) is a serious cardiovascular disorder in patients with spinal cord injury (SCI). The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons (SPNs) caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Cen...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Medknow Publications & Media Pvt Ltd
2017
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649450/ https://www.ncbi.nlm.nih.gov/pubmed/29089975 http://dx.doi.org/10.4103/1673-5374.215241 |
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author | Sharif, Hisham Hou, Shaoping |
author_facet | Sharif, Hisham Hou, Shaoping |
author_sort | Sharif, Hisham |
collection | PubMed |
description | Autonomic dysreflexia (AD) is a serious cardiovascular disorder in patients with spinal cord injury (SCI). The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons (SPNs) caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes. In parallel, upregulated peripheral vascular sensitivity following SCI exacerbates the hypertensive response by augmenting gastric and pelvic vasoconstriction. Currently, the majority of clinically employed treatments for AD involve anti-hypertensive medications and Botox injections to the bladder. Although these approaches mitigate the severity of AD, they only yield transient effects and target the effector organs, rather than addressing the primary issue of central sympathetic dysregulation. As such, strategies that aim to restore supraspinal reinnervation of SPNs to improve cardiovascular sympathetic regulation are likely more effective for AD. Recent pre-clinical investigations show that cell transplantation therapy is efficacious in reestablishing spinal sympathetic connections and improving hemodynamic performance, which holds promise as a potential therapeutic approach. |
format | Online Article Text |
id | pubmed-5649450 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-56494502017-10-31 Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury Sharif, Hisham Hou, Shaoping Neural Regen Res Invited Review Autonomic dysreflexia (AD) is a serious cardiovascular disorder in patients with spinal cord injury (SCI). The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons (SPNs) caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes. In parallel, upregulated peripheral vascular sensitivity following SCI exacerbates the hypertensive response by augmenting gastric and pelvic vasoconstriction. Currently, the majority of clinically employed treatments for AD involve anti-hypertensive medications and Botox injections to the bladder. Although these approaches mitigate the severity of AD, they only yield transient effects and target the effector organs, rather than addressing the primary issue of central sympathetic dysregulation. As such, strategies that aim to restore supraspinal reinnervation of SPNs to improve cardiovascular sympathetic regulation are likely more effective for AD. Recent pre-clinical investigations show that cell transplantation therapy is efficacious in reestablishing spinal sympathetic connections and improving hemodynamic performance, which holds promise as a potential therapeutic approach. Medknow Publications & Media Pvt Ltd 2017-09 /pmc/articles/PMC5649450/ /pubmed/29089975 http://dx.doi.org/10.4103/1673-5374.215241 Text en Copyright: © Neural Regeneration Research http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Invited Review Sharif, Hisham Hou, Shaoping Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury |
title | Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury |
title_full | Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury |
title_fullStr | Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury |
title_full_unstemmed | Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury |
title_short | Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury |
title_sort | autonomic dysreflexia: a cardiovascular disorder following spinal cord injury |
topic | Invited Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649450/ https://www.ncbi.nlm.nih.gov/pubmed/29089975 http://dx.doi.org/10.4103/1673-5374.215241 |
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