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. 2022 Jul 7;12(7):1110.
doi: 10.3390/jpm12071110.

Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review

Austin M Henke  1   2 , Zackery J Billington  1   2 , David R Gater Jr  1   2   3
Affiliations

Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review

Austin M Henke et al. J Pers Med. .

Abstract

The autonomic nervous system (ANS), composed of the sympathetic and parasympathetic nervous systems, acts to maintain homeostasis in the body through autonomic influences on the smooth muscle, cardiac muscles, blood vessels, glands and organs of the body. The parasympathetic nervous system interacts via the cranial and sacral segments of the central nervous system, and the sympathetic nervous system arises from the T1-L2 spinal cord segments. After a spinal cord injury (SCI), supraspinal influence on the ANS is disrupted, leading to sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. Further, afferent signals to the sympathetic cord elicit unabated reflex sympathetic outflow in response to noxious stimuli below the level of SCI. This article outlines the pathophysiology of SCI on the ANS, clinical ramifications of autonomic dysfunction, and the potential long-term sequelae of these influences following SCI.

Keywords: autonomic dysfunction; autonomic dysreflexia; orthostatic hypotension; paraplegia; spinal cord injury; tetraplegia; thermoregulatory dysfunction.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Main effectors and effects of the sympathetic system. The effects of the sympathetic system are mediated by neurons of the paravertebral and prevertebral ganglia and by the adrenal medulla. SCG, superior cervical ganglion. With permission from E.E. Benarroch. Autonomic Neurology. Oxford University Press. NY, NY. © Mayo Foundation for Medical Education and Research 2014.
Figure 2
Figure 2
Main effectors and effects of the parasympathetic system. The effects of the parasympathetic system are mediated by neurons located in the vicinity or within the wall of the effector structures. With permission from E.E. Benarroch. Autonomic Neurology. Oxford University Press. NY, NY. © Mayo Foundation for Medical Education and Research 2014.
Figure 3
Figure 3
Management algorithm for Autonomic Dysreflexia. Reprinted with permission from Topics in Spinal Cord Injury Rehabilitation, Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions: Preventing the Highs and Lows: Management of Blood Pressure, Sweating, and Temperature Dysfunction. Krassioukov et al. TSCIR 2021;27(2):225–290. Copyright 2021 by American Spinal Injury Association.
See this image and copyright information in PMC

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