Curt A, Weinhardt C, Dietz V
Swiss Paraplegic Centre, University Hospital Balgrist, Zürich, Switzerland.
J Auton Nerv Syst. 1996 Nov 6;61(2):175-80. doi: 10.1016/s0165-1838(96)00080-x.
As a result of spinal cord injury (SCI) descending spinal sympathetic pathways can be severed. Because of its clinical significance, the aim of this study was to assess the disturbance of the spinal sympathetic pathway by clinical and electrophysiological examinations. The sympathetic skin response (SSR) due to electrical stimulation of median nerve and transcranial magnetic stimulation was examined in 70 patients with complete and incomplete spinal cord injury. Clinical and neurological examinations were performed in these patients according to the protocol of the American Spinal Injury Association (ASIA). The SSR can be used to assess the integrity of the spinal sympathetic nervous system. In patients with complete tetraplegia and paraplegics with high thoracical lesions (up to level T3) SSRs of the hands and feet were absent. In patients with complete paraplegia and thoroacic lesions from level T4 up to T8 the SSRs could be evoked in the hands but not in the feet. However, in paraplegics with lumbal and thoracic lesions below level T8 SSRs of the hands and feet could be recorded. In about 50% of the patients with clinically incomplete SCI lesions SSR potentials were abolished, indicating that the spinal sympathetic system was severely affected. There was no patient with preserved SSR potentials who developed symptoms of autonomic dysreflexia (AD). However, all patients with episodes of AD showed abolished SSR at the hands and feet even in incomplete SCI patients. The results of the SSR recordings in SCI patients fit with the assumption that the development of AD is related to the disconnection of the spinal sympathetic centers from supraspinal control.
由于脊髓损伤（SCI），脊髓下行交感神经通路可能会被切断。鉴于其临床意义，本研究旨在通过临床和电生理检查评估脊髓交感神经通路的紊乱情况。对70例完全性和不完全性脊髓损伤患者进行了正中神经电刺激和经颅磁刺激引起的交感皮肤反应（SSR）检查。根据美国脊髓损伤协会（ASIA）的方案对这些患者进行了临床和神经学检查。SSR可用于评估脊髓交感神经系统的完整性。在完全性四肢瘫患者和高位胸段损伤（至T3水平）的截瘫患者中，手足的SSR消失。在完全性截瘫且胸段损伤从T4水平至T8水平的患者中，手部可诱发SSR，但足部不能。然而，在胸段和腰段损伤低于T8水平的截瘫患者中，手足的SSR均可记录到。在约50%临床SCI损伤不完全的患者中，SSR电位消失，表明脊髓交感神经系统受到严重影响。没有保留SSR电位的患者出现自主神经反射异常（AD）症状。然而，所有出现AD发作的患者，即使是不完全性SCI患者，其手足的SSR也均消失。SCI患者SSR记录的结果符合以下假设：AD的发生与脊髓交感神经中枢与脊髓上控制的脱节有关。
