Abstract
Cerebral blood flow has been measured by a Xenon 133 inhalation technique in patients with chronic high spinal cord injuries and neurological disorders affecting the sympathetic pathways supplying intracranial vessels. These included patients with idiopathic orthostatic hypotension and also patients with a physiologically complete cervical cord transection. Cerebral blood flow and arterial blood pressure were measured in the supine position and then in the sitting position. Patients in whom the mean blood pressure fell in the sitting position to 70 mm. Hg had no change in cerebral blood flow during the period of hypotension. In all subjects the response of cerebral blood flow to hyperventilation for five minutes was measured in the supine position and compared with that in normal ‘control’ subjects.
Hyperventilation resulted in the same decrease of cerebral blood flow in the controls as in the subjects with paraplegia or other neurological disorders. It is concluded that the responses of the cerebral circulation to hypotension and to hypocapnia were normal in all patients studied, including those with high spinal cord transection. The mechanisms involved in these responses are therefore independent of control via sympathetic pathways.
Similar content being viewed by others
Article PDF
References
Andrews, C J H, Andrews, W H H & Orbach, J (1971). A spinal autonomic reflex evoked by congestion of the mesenteric vein. J. Physiol. (Lond.), 213, 37–38.
Beacham, W S & Kunze, D L (1969). Renal receptors evoking a spinal vasomotor reflex. J. Physiol. (Lond.), 201, 73–85.
Caronna, J J & Plum, F (1973). Cerebrovascular regulation in preganglionic and postganglionic autonomic insufficiency. Stroke, 4, 12–19.
Corbett, J L, Frankel, H L & Harris, P J (1971a). Cardiovascular changes associated with skeletal muscle spasm in tetraplegic man. J. Physiol. (Lond.), 215, 318–393.
Corbett, J L, Frankel, H L & Harris, P J (19716). Cardiovascular reflex responses to cutaneous and visceral stimuli in spinal man. J. Physiol. (Lond.), 215, 395–409.
Dahl, E (1973). The innervation of the cerebral arteries. J. Anat. 115, 53–63.
Debarge, O, Christensen, N J, Corbett, J L, Eidelman, B H, Frankel, H L & Mathias, C J (1974). Plasma catecholamines in tetraplegics. Paraplegia, 12, 44–49.
Eidelman, B H, Corbett, J L, Debarge, O & Frankel, H (1972). Absence of cerebral vasoconstriction with hyperventilation in tetraplegic man. Lancet, ii, 457–460.
Fieschi, C & Bozzao, L (1972). Clinical aspects of regional cerebral blood flow. In Progress in Brain Research, Vol. 35, Eds. Meyer, J. S. and Schadé, J. P., pp. 387–410. Amsterdam: Elsevier.
Gilliatt, R W (1948). Vasoconstriction in the fingers after deep inspiration. J. Physiol. (Lond.), 107, 76–88.
Gilliatt, R W, Guttmann, L & Whitteridge, D (1948). Inspiratory vasoconstriction in patients after spinal injuries. J. Physiol. (Lond.), 107, 67–75.
Gotoh, F, Ebihara, S -L, Toyoda, M & Shinohara, Y (1971-72). Role of autonomic nervous system in autoregulation of human cerebral circulation. In Cerebral Blood Flow and Intracranial Pressure. Proceedings of the Fifth International Symposium. Roma-Siena. Part I, Europ. Neurol. 6, 203–207.
Guttmann, L (1953). Significance of vasomotor control for postural readjustment in the spinal man (in the treatment and rehabilitation of patients with injuries of the spinal cord, pages 436-7). History of Second World War, Vol. Surgery. London: H.M. Stationery Office.
Guttmann, L, Munro, A F, Robinson, R & Walsh, J J (1963). Effect of tilting on the cardiovascular responses and plasma catecholamine levels in spinal man. Paraplegia, 1, 4–18.
Guttmann, L & Whitteridge, D (1947). Effect of bladder distension on autonomic mechanisms after spinal cord injuries. Brain, 70, 361–404.
Harper, A M Autonomic control of cerebral blood flow. In Proceedings of Ninth Princeton Conference on Cerebral Vascular Diseases (1974). Eds. Whisnant, J. P. and Sandok, B. A. (In press.)
Høedt-Rasmussen, K, Sveinsdottir, E & Lassen, N A (1966). Regional cerebral blood flow in man determined by intra-arterial injection of radioactive inert gas. Circulation Res. 18, 237–247.
Hoff, J T, Sengupta, D, Harper, A M & Jennett, W B (1972). Effect of alpha-adrenergic blockade on response of cerebral circulation to hypocapnia in the baboon. Lancet, ii, 1137–1139.
James, I M, Millar, R A & Purves, M J (1969). Observations on the extrinsic neural control of cerebral blood flow in the baboon. Circulation Res. 25, 77–93.
Johnson, R H & Park, D M (1973). Effect of change of posture on blood pressure and plasma renin concentration in men with spinal transection. Clin. Sci. 44, 539–546.
Johnson, R H, Park, D M & Frankel, H L (1971). Orthostatic hypotension and the renin-angiotensin system in paraplegia. Paraplegia, 9, 146–152.
Lassen, N A (1974). Control of cerebral circulation in health and disease. Circulation Res. 34, 749.
Love, D R, Brown, J J, Chinn, R H, Johnson, R H, Lever, A F, Park, D M & Robertson, J I S (1971). Plasma renin in idiopathic orthostatic hypotension: differential response in subjects with probable afferent and efferent autonomic failure. Clin. Sci. 41, 289–299.
Mallett, B L & Veall, N (1966). Regional cerebral blood flow determination by 133Xe inhalation and external recording: the effect of arterial recirculation. Clin. Sci. 30, 353–369.
Meyer, J S, Kunio, S, Fukunchi, Y, Ohuchi, T, Okamoto, S, Koto, A & Ericsson, A D (1973). Cerebral dysautoregulation in cerebral neurogenic orthostatic hypotension (Shy-Drager syndrome). Neurology, 23, 262–273.
Ponte, J & Purves, M J (1974). The role of the carotid body chemoreceptors and carotid sinus baroreceptors in the control of cerebral blood vessels. J. Physiol. (Lond.), 237, 315–340.
Sharpey-Schafer, E P (1961). Venous tone. Brit. med. J., ii, 1589–1595.
Skinhøj, E, Olesen, J & Strandgaard, S (1971). Autoregulation and the sympathetic nervous system: a study in a patient with idiopathic orchostatic hypotension. In Brain and Blood Flow. Proceedings of the Fourth International Symposium on the Regulation of Cerebral Blood Flow. Ed. Ross Russell, R. W., p. 351. London: Pitman Scientific.
Wilkinson, I M S (1972). Regional cerebral blood flow in man. In Progress in Brain Research, Vol. 35, Eds. Meyer, J. S. and Schadé, J. P., pp. 87–103. Amsterdam: Elsevier.
Wyper, D J & Rowan, J O Regional cerebral blood flow maps. In Proceedings of HPA /BES Conference on Clinical Blood Flow Measurement—Cardiff (1974). (In press.)
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nanda, R., Wyper, D., Harper, A. et al. Cerebral blood flow in paraplegia. Spinal Cord 12, 212–218 (1974). https://doi.org/10.1038/sc.1974.34
Issue Date:
DOI: https://doi.org/10.1038/sc.1974.34
This article is cited by
-
A cerebral blood flow evaluation during cognitive tasks following a cervical spinal cord injury: a case study using transcranial Doppler recordings
Cognitive Neurodynamics (2015)
-
Effect of hypotensive challenge on systemic hemodynamics and cerebral blood flow in persons with tetraplegia
Clinical Autonomic Research (2009)
-
Dysautoregulation of the Cerebral Circulation in Primary Systemic Amyloidosis
Journal of Cerebral Blood Flow & Metabolism (1984)