Schaller B
Max-Planck-Institute for Neurological Research, Gleueler Strasse 50, 50931 Cologne, Germany.
J Neurol. 2004 Jun;251(6):658-65. doi: 10.1007/s00415-004-0458-4.
The trigemino-cardiac reflex (TCR) is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. The sensory nerve endings of the trigeminal nerve send neuronal signals via the Gasserian ganglion to the sensory nucleus of the trigeminal nerve, forming the afferent pathway of the reflex arc. This afferent pathway continues along the short internuncial nerve fibers in the reticular formatio to connect with the efferent pathway in the motor nucleus of the vagus nerve. Clinically, the trigemino-cardiac reflex has been reported to occur during craniofacial surgery, balloon-compression rhizolysis of the trigeminal ganglion, and tumor resection in the cerebellopontine angle. Apart from the few clinical reports, the physiological function of this brainstem-reflex has not yet been fully explored. From experimental findings, it may be suggested that the trigemino-cardiac reflex represents an expression of a central neurogenic reflex leading to rapid cerebrovascular vasodilatation generated from excitation of oxygen-sensitive neurons in the rostral ventrolateral medulla oblongata. By this physiological response, the adjustments of the systemic and cerebral circulations are initiated to divert blood to the brain or to increase blood flow within it. As it is generally accepted that the diving reflex and ischemic tolerance appear to involve at least partially similar physiological mechanisms, the existence of such endogenous neuroprotective strategies may extend the actually known clinical appearance of the TCR and include the prevention of other potentially brain injury states as well. This may be in line with the suggestion that the TCR is a physiological, but not a pathophysiological entity.
三叉神经心脏反射（TCR）的定义为：在刺激三叉神经的任何感觉分支时，突然出现的副交感神经节律紊乱、交感神经低血压、呼吸暂停或胃动力亢进。三叉神经的感觉神经末梢通过半月神经节将神经元信号发送至三叉神经感觉核，形成反射弧的传入通路。该传入通路沿着网状结构中的短联络神经纤维继续延伸，与迷走神经运动核中的传出通路相连。临床上，据报道三叉神经心脏反射可发生于颅面外科手术、三叉神经节球囊压迫性神经根切断术以及桥小脑角肿瘤切除术期间。除了少数临床报告外，这种脑干反射的生理功能尚未得到充分探索。从实验结果来看，可能提示三叉神经心脏反射代表一种中枢神经源性反射的表现，该反射导致延髓头端腹外侧对氧敏感的神经元兴奋后引起脑血管迅速扩张。通过这种生理反应，启动全身和脑循环的调节，使血液转向大脑或增加大脑内的血流量。由于普遍认为潜水反射和缺血耐受性似乎至少部分涉及相似的生理机制，这种内源性神经保护策略的存在可能会扩展三叉神经心脏反射实际已知的临床表现，还包括预防其他潜在的脑损伤状态。这可能与三叉神经心脏反射是一种生理而非病理生理实体的观点一致。
