OBJECTIVE: To find evidence of autonomic imbalance and present the heart rate variability (HRV) parameters that reflect the severity of paroxysmal sympathetic hyperactivity (PSH) in children with acquired brain injury (ABI). METHODS: Thirteen children with ABI were enrolled and age- and sex-matched children with cerebral palsy were selected as the control group (n=13). The following HRV parameters were calculated: time-domain indices including the mean heart rate, standard deviation of all average R-R intervals (SDNN), root mean square of the successive differences (RMSSD), physical stress index (PSI), approximate entropy (ApEn); successive R-R interval difference (SRD), and frequency domain indices including total power (TP), high frequency (HF), low frequency (LF), normalized HF, normalized LF, and LF/HF ratio. RESULTS: There were significant differences between the ABI and control groups in the mean heart rate, RMSSD, PSI and all indices of the frequency domain analysis. The mean heart rate, PSI, normalized LF, and LF/HF ratio increased in the ABI group. The presence of PSH symptoms in the ABI group demonstrated a statistically significant decline of the SDNN, TP, ln TP. CONCLUSION: The differences in the HRV parameters and presence of PSH symptoms are noted among ABI children compared to an age- and sex-matched control group with cerebral palsy. Within the ABI group, the presence of PSH symptoms influenced the parameters of HRV such as SDNN, TP and ln TP.
Autonomic Nervous System ; Brain Injuries* ; Brain* ; Cerebral Palsy ; Child* ; Entropy ; Heart Rate* ; Heart* ; Humans ; Parasympathetic Nervous System ; Sympathetic Nervous System

OBJECTIVE: The aims of this study is to determine the influence of the imbalance between sympathetic and parasympathetic nervous input to colon transit control in spinal cord injured patients and the effect of the anticholinergic medication forneurogenic bladder on colon transit time. METHOD: Eighty-six patients with cervical and thoracic cord injury were enrolled. The colon transit time (CTT) accord ing to the severity and lesion of injury and also the administration routes of oxybutynin were compared by indepen dent t-test. RESULTS: Total CTT was 56.7 hours, with right CTT 16.9 hours, left CTT 21.3 hours and rectosigmoid CTT 18.5 hours. The rectosigmoid CTT of the patients with the lesion at T6 or below were prolonged than that of the patients with the lesion above T6 (p<0.05). According to administration route of oxybutynin, instillation group showed more shortened rectosigmoid CTT than oral route group (p<0.05). CONCLUSION: The imbalance between parasympathetic and sympathetic outflow from the spinal cord has play an im portant role in colon transit control of spinal cord injured patients. The management of neurogenic bowel and bladder considering colon transit time is needed for the effective management of spinal cord injured patients.
Autonomic Nervous System ; Colon* ; Humans ; Neurogenic Bowel ; Spinal Cord Injuries ; Spinal Cord* ; Sympathetic Nervous System* ; Urinary Bladder ; Urinary Bladder, Neurogenic

Electrical shock can result in neurological complications, involving both peripheral and central nervous systems, which may present immediately or later on. However, delayed neurological complications caused by low-voltage electric shock are rarely reported. Here, a case of a man suffering from weakness and aphasia due to the delayed-onset of the peripheral nerve injury and ischemic stroke following an electrical shock is presented. Possible mechanisms underlying the neurological complications include thermal injury to perineural tissue, overactivity of the sympathetic nervous system, vascular injury, and histological or electrophysiological changes. Moreover, vasospasms caused by low-voltage alternating current may predispose individuals to ischemic stroke. Therefore, clinicians should consider the possibility of neurological complications, even if the onset of the symptoms is delayed, and should perform diagnostic tests, such as electrophysiology or imaging, when patients present with weakness following an electric injury.
Aphasia ; Central Nervous System ; Diagnostic Tests, Routine ; Electric Injuries* ; Electrophysiology ; Humans ; Peripheral Nerve Injuries ; Shock ; Stroke ; Sympathetic Nervous System ; Vascular System Injuries

Activation of the sympathetic nervous system in mediating the stress response attends traumatic brain injury. Plasma dopamine(DA), epinephrine(E), norepinephrine(NE) levels were measured in 26 severe traumatically brain injured patients to determine whether catecholamine levels obtained within 24 hours after injury provide reliable prognostic endogenous markers of outcome. Patient outcome was determine at 1 week using the Glasgow Coma Scale(GCS) and at the time of discharge the Glasgow Outcome Scale(GOS), 7 patients with diseases except those with a severe traumatic brain injury were selected as a control group. Firstly, we analyzed the difference of the average DA, E, and NE between the control group and severe traumatic brain injury patients. Secondly, we analyzed the difference of the average catecholamine levels in the 3 groups according to admission GCS scores(respectively 3~4, 5~7, 8~9). Third, we analyzed the difference of the average catecholamine levels in the 5 groups according to GOS scores at 1 week(respectively dead, 3~4, 5~7, 8~11, >11). Finally, we analyzed the difference of the average catecholamine levels in the 5 groups according to GOS at the time of discharge. As a result, there was no statical difference between the level of DA in the control group and those of the severe brain injury patients. But the level of E an NE in the experimental group were higher than the control group(respectively p<0.03, p<0.04). The admission GCS score correlated highly with the catecholamine levels(NE : r=0.69, p<0.001 ; E ; r=0.42, p<0.03 ; DA ; r=0.42, p<0.03). In patients with admission GCS of 3 to 4, NE levels increaed fourfold above other group(p<0.005). In the 13 patients with GCS scores of 3 or 4 on admission. NE levels predicted outcome at 1 week. All two patients with NE levels less then 750 pg/ml were survived, while 10 of 11 with NE levels greater than 750 pg/ml were died(p<0.02). The levels of NE was significantly higher in patients who died than in those with better outcome(p<0.02). Therefore, these findings indicated that the level of circulating NE is an excellent endogenous marker that appear to reflect the extent of brain injury and that may predict the likelihood of recovery.
Brain ; Brain Injuries* ; Coma ; Dopamine ; Epinephrine ; Humans ; Negotiating ; Norepinephrine ; Plasma* ; Prognosis* ; Sympathetic Nervous System

The genital organ is innervated by autonomic and somatic nerve. The former is both sympathetic and parasympathetic nerve and the later is comprised by sensory and motor fibers. The symptoms of male sexual dysfunction are sexopathy, erectile dysfunction, disorder of ejaculation and orgasm, and pianism. Not only different symptom but the same symptom can be induced by different injured nerve. The relationship between peripheral nerve injury and male sexual dysfunction should be understood correctly.
Erectile Dysfunction/etiology* ; Humans ; Male ; Parasympathetic Nervous System/injuries* ; Pelvis/innervation* ; Peripheral Nerve Injuries ; Peripheral Nerves/anatomy & histology* ; Sexual Dysfunction, Physiological/etiology* ; Spinal Cord Injuries/complications* ; Sympathetic Nervous System/injuries* ; Trauma, Nervous System/complications*

OBJECTIVE: Peripheral nerve injury often leads to neuropathic pain, which is characterized by burning pain, allodynia, and hyperalgesia. The role of the sympathetic nervous system in neuropathic pain is a complex and controversial issue. It is generally accepted that the alpha adrenoreceptor (AR) in sympathetic nerve system plays a significant role in the maintenance of pain. Among alpha adrenoreceptor, alpha-1 receptors play a major role in the sympathetic mediated pain. The primary goal of this study is to test the hypothesis that sympathetically maintained pain involves peripheral alpha-2 receptors in human. METHODS: The study was a randomized, prospective, double-blinded, crossover study involving twenty patients. The treatments were : Yohimbine (30 mg mixed in 500 mL normal saline), and Phentolamine (1 mg/kg in 500 mL normal saline) in 500 mL normal saline at 70 mL/hr initially then titrated. The patients underwent infusions on three different appointments, at least one month apart. Thus, all patients received all 2 treatments. Pain measurement was by visual analogue scale, neuropathic pain questionnaire, and McGill pain questionnaire. RESULTS: There were significant decreases in the visual analogue scale, neuropathic score, McGill pain score of yohimnine, and phentolamine. CONCLUSION: We conclude that alpha-2 adrenoreceptor, along with alpha-2 adrenoreceptor, may be play role in sympathetically maintained pain in human.
Appointments and Schedules ; Burns ; Cross-Over Studies ; Humans ; Hyperalgesia ; Neuralgia ; Pain Measurement ; Peripheral Nerve Injuries ; Phentolamine ; Prospective Studies ; Surveys and Questionnaires ; Reflex Sympathetic Dystrophy ; Sympathetic Nervous System ; Yohimbine

This study was undertaken to determine the cardiovascular response to the spinal cord trauma in cats and to determine the autonomic mechnisms involved. The electrocardiogram and arterial blood pressure were recorded in anesthetized cats after the spinal cord trauma of 500 gm-cm at T4-T6 levels. 1. Acute spinal cord trauma caused a wide variety of severe cardiac arrhythmias and acute hypertension. 2. The increase of blood pressure could be prevented by intravenous phenoxybenzamine, and alpha adrenergic blocking agent. The pressor response was mediated by the alpha adrenergic receptor sites of the peripheral nervous system. 3. Tachycardia was occurred by the administration of atropine and bilateral vagotomy before trauma without affecting pressor response. 4. The arrhythmias could be eliminated by the combined administration of propranolol and atropine, but not prevented by the administration of either propranolol or atropine without affecting pressor response. These results suggest that the arrhythmias might be a response of hyperactivity of both sympathetic and parasympathetic divisions of the autonomic nervous system.
Animals ; Arrhythmias, Cardiac* ; Arterial Pressure ; Atropine ; Autonomic Nervous System ; Blood Pressure ; Cats* ; Electrocardiography ; Hypertension ; Parasympathetic Nervous System ; Peripheral Nervous System ; Phenoxybenzamine ; Propranolol ; Receptors, Adrenergic ; Spinal Cord Injuries* ; Spinal Cord* ; Sympathetic Nervous System ; Tachycardia ; Vagotomy

BACKGROUND: Transient global cerebral ischemia can cause selective hippocampal lesion and spatial learning impairment. To evaluate whether some commonly used laboratory animal anesthetics, pentobarbital, ketamine and xylazine, can affect ischemic brain injury, the effects of the anesthetics on Morris water maze task following transient global ischemia were investigated in Mongolian gerbils. METHODS: The ischemia was induced by bilateral carotid artery occlusion for 2 or 5 min. Morris water maze task was started 3 days later and performed for 15 days. RESULTS: Every animal acquired Morris water maze task as trial proceeded and there was no difference in the latency time on the last (15th) trial. However the ischemic groups (2 min and 5min) showed delayed acquisition of a Morris water maze task and the longer the ischemic time was the more the acquisition delayed. There were no differences in the acquisition of the maze task among pentobarbital-, ketamine- and ketamine/xylazine-anesthesia in either sham- or 2 min-ischemic group, but ketamine/ xylazine anesthesia significantly reduced the acquisition delay in 5 min-ischemic group compared with pentobarbital- or ketamine-anesthesia. CONCLUSIONS: These results suggest that ketamine/xylazine anesthesia have more neuroprotective effect on ischemia-induced brain injury, compared with pentobarbital- or ketamine-anesthesia, in gerbil global ischemia.
Anesthesia ; Anesthetics ; Animals ; Animals, Laboratory ; Brain ; Brain Injuries ; Brain Ischemia ; Carotid Arteries ; Gerbillinae* ; Ischemia* ; Ketamine* ; Learning* ; Neuroprotective Agents ; Pentobarbital* ; Sympathetic Nervous System ; Xylazine*

Cervical spinal cord injury results in significant dysfunction of the sympathetic nervous system. Reduced sympathetic activity below the level of spinal cord injury is associated with low resting blood pressure,orthostatic hypotension,and reflex bradycardia.Hypotension can be treated with vasoactive agents,such as dopamine,epinephrine,norepinephrine, and phenylephine .Orally administered midodrine is an alpha adrenergic receptor agonist that increases blood pressure with vasoconstriction.Its action is fast and effective in treating hypotension in patients with spinal cord injury,and it has less severe side effects.A 70-year-old tetraplegic patient with fracture and dislocation of C6-7 after a motor vehicle accident was admitted to ICU and underwent anterior cervical intervertebral body fusion.Symptomatic hypotension following postural changes was treated with intravenous infusion of dopamine,but it was difficult to reduce the dose of dopamine without causing severe hypotension.Midodrine was prescribed and the patient was well tolerated without any adverse effect.With adequately maintained blood pressure,intravenous infusion of dopamine was successfully switched to the oral midodrine.This case suggests that the midodrine is effective for the treatment of hypotension in tetraplegic patients with spinal cord injury and enables patients to participate in early rehabilitation therapies.
Adrenergic alpha-Agonists ; Aged ; Blood Pressure ; Dislocations ; Dopamine ; Humans ; Hypotension* ; Infusions, Intravenous ; Midodrine* ; Motor Vehicles ; Quadriplegia ; Reflex ; Rehabilitation ; Spinal Cord ; Spinal Cord Injuries ; Sympathetic Nervous System

PURPOSE: In treating schwannoma patients, it is critical to determine the origin of the tumor to preserve nerve function. We evaluated the validity of preoperative imaging studies in distinguishing the neurological origin of the schwannomas of the head and neck, and the efficacy of intracapsular enucleation in preserving nerve function. MATERIALS AND METHODS: In 7 cases of schwannomas in the head and neck region, we predicted whether the tumor originated from the vagus nerve or the cervical sympathetic chain through imaging studies including computed tomography (CT) and magnetic resonance imaging (MRI). All patients were performed intracapsular enucleation, and the function of the vagus nerve and the sympathetic nerve was evaluated preoperatively and postoperatively. RESULTS: Preoperative imaging studies showed 6 cases where the tumor was located between the carotid artery and the internal jugular vein, and 1 case where the tumor was located posteriorly, displacing the carotid artery and the internal jugular vein anteriorly. At the time of operation, we confirmed schwannoma originating from the vagus nerve on the first 6 cases, and schwannoma originating from the sympathetic nervous system on the last case. All patients went through successful intracapsular enucleation, and of the seven schwannoma cases, 6 patients maintained normal postoperative neurological function (85.7%). CONCLUSION: Preoperative imaging studies offer valuable information regarding the location and origination of the tumor, and intracapsular enucleation helped us to preserve the nerve function.
Aged ; Diagnostic Imaging/methods ; Female ; Follow-Up Studies ; Head and Neck Neoplasms/complications/diagnosis/*pathology ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Neurilemmoma/complications/diagnosis/*pathology ; Peripheral Nervous System/injuries/physiology ; Sympathetic Nervous System/physiology ; Tomography, X-Ray Computed/methods ; Treatment Outcome ; Vagus Nerve/physiology