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Journal of the Neurological Sciences Sep 2017The detailed pathophysiology of limb coldness in multiple system atrophy (MSA) is unknown.
BACKGROUND
The detailed pathophysiology of limb coldness in multiple system atrophy (MSA) is unknown.
METHODS
We evaluated cutaneous vasomotor neural function in 18 MSA patients with or without limb coldness, and in 20 healthy volunteers as controls. We measured resting skin sympathetic nerve activity (SSNA) and spontaneous changes of the sympathetic skin response (SSR) and skin blood flow (skin vasomotor reflex: SVR), as well as SVR and reflex changes of SSNA after electrical stimulation. The parameters investigated were the SSNA frequency at rest, amplitude of SSNA reflex bursts, absolute decrease and percent reduction of SVR, recovery time, and skin blood flow velocity.
RESULTS
Both the resting frequency of SSNA and the amplitude of SSNA reflex bursts were significantly lower in the MSA group than the control group (p<0.001 and p<0.05, respectively). There were no significant differences between the two groups with regard to the absolute decrease or percent reduction of SVR volume. The recovery time showed no significant difference between all MSA patients and control groups, but it was significantly prolonged in six MSA patients with limb coldness compared with that in the control group and that in MSA patients without limb coldness (p<0.01). The skin blood flow velocity was significantly slower in the MSA group than in the control group (p<0.001).
CONCLUSION
In MSA patients, limb coldness might occur due to impairments of the peripheral circulation based on prolongation of vasoconstriction and a decrease of skin blood flow velocity secondary to combined pre- and postganglionic skin vasomotor dysfunction.
Topics: Aged; Autonomic Fibers, Postganglionic; Autonomic Fibers, Preganglionic; Blood Flow Velocity; Electric Stimulation; Female; Humans; Laser-Doppler Flowmetry; Male; Middle Aged; Multiple System Atrophy; Reflex; Skin; Sympathetic Fibers, Postganglionic; Vascular Diseases; Vasoconstriction
PubMed: 28870566
DOI: 10.1016/j.jns.2017.07.018 -
Journal of the Autonomic Nervous System Dec 1989The origins and organization of cardiac sympathetic postganglionic nerves in the rat were identified in the present investigation. The retrograde tracer, Diamidino...
The origins and organization of cardiac sympathetic postganglionic nerves in the rat were identified in the present investigation. The retrograde tracer, Diamidino Yellow, was injected into the right or left ventricles to label somata in the sympathetic chain. Analysis of all sympathetic ganglia from superior cervical ganglion through the 10th thoracic ganglion indicated that the postganglionic innervation of the rat cardiac ventricles originates bilaterally. The majority of these somata were located in the middle and inferior cervical ganglia (middle cervical-stellate ganglion complex) (approximately 92% of all labelled cells), with lesser contributions from the superior cervical and 4th through 6th thoracic ganglia. To confirm and further quantitate these findings, the middle cervical-stellate ganglion complex was removed (MC-S ganglionectomy) bilaterally or ipsilaterally from the left or right sides, and regional cardiac norepinephrine concentration (left and right atrial appendages and left and right ventricles) was analysed 7 or 28 days later. At both times after bilateral MC-S ganglionectomy, regional cardiac norepinephrine was reduced by 89% to 100%, indicating the removal of almost all cardiac noradrenergic cells of origin and possibly fibers of passage. The results of unilateral MC-S ganglionectomy experiments indicated that the atrial appendages and the left ventricle receive bilateral innervation from the middle cervical-stellate ganglion complex. However, the left middle cervical-stellate ganglion complex appears to contribute a majority of the norepinephrine to the right ventricle. Furthermore, between 7 and 28 days after contralateral MC-S ganglionectomy, atrial appendages, but not ventricles, display significant recovery of norepinephrine content. The present data demonstrate: (1) a bilateral locus of origin of cardiac sympathetic postganglionic neurons, limited longitudinally to cervical through mid-thoracic ganglia, and (2) the ability of the cardiac postganglionic innervation to regenerate after partial denervation. These results demonstrate anatomical evidence for significant bilateral integration of cardiac sympathetic activity at the level of the sympathetic ganglion in the rat.
Topics: Amidines; Animals; Autonomic Fibers, Postganglionic; Fluorescent Dyes; Ganglia, Sympathetic; Heart; Myocardium; Norepinephrine; Rats; Rats, Inbred Strains
PubMed: 2628461
DOI: 10.1016/0165-1838(89)90146-x -
European Neurology 1993Two cases of pure progressive autonomic failure (PAF) are presented. A postmortem study of one case (case 2) showed a pathology resembling that of Parkinson's disease.... (Review)
Review
Two cases of pure progressive autonomic failure (PAF) are presented. A postmortem study of one case (case 2) showed a pathology resembling that of Parkinson's disease. Marked cell loss was noted in the substantia nigra, nucleus ceruleus, and intermediolateral column of the spinal cord, while cell loss in the sympathetic ganglion was not remarkable. This case may be an exceptionally rare case of late-onset PAF in which autonomic failure was mainly ascribed to preganglionic (and central) pathology, although autonomic function tests suggested postganglionic sympathetic disorder in both cases.
Topics: Aged; Aged, 80 and over; Autonomic Fibers, Postganglionic; Autonomic Fibers, Preganglionic; Autonomic Nervous System Diseases; Biopsy; Brain; Diagnosis, Differential; Ganglia, Sympathetic; Humans; Male; Nerve Degeneration; Neurologic Examination; Parkinson Disease; Sural Nerve
PubMed: 8307061
DOI: 10.1159/000116985 -
Acta Neurobiologiae Experimentalis 1977The stimulation of arterial baroreceptors (blind sack technique) inhibited the preganglionic and postganglionic cardiac sympathetic activity. There were found three...
The stimulation of arterial baroreceptors (blind sack technique) inhibited the preganglionic and postganglionic cardiac sympathetic activity. There were found three populations of single sympathetic preganglionic fibers (Th3) responding in a different way to the stimulation of arterial baroreceptors and arterial chemoreceptors (infusion of the small volume of saline bubbled with CO2 into the carotid sinus): (i) inhibited by carotid baroreceptors and excited by carotid chemoreceptors stimulation, (ii) inhibited by carotid baroreceptors and by carotid chemoreceptors stimulation, (iii) some fibers inhibited by baroreceptors did not change activity during stimulation of chemoreceptors. A functional role of each particular group of preganglionic sympathetic fibers is discussed.
Topics: Action Potentials; Animals; Autonomic Fibers, Postganglionic; Autonomic Fibers, Preganglionic; Carotid Sinus; Cats; Chemoreceptor Cells; Ganglia, Autonomic; Heart; Heart Rate; Pressoreceptors; Sympathetic Nervous System
PubMed: 855684
DOI: No ID Found -
Philosophical Transactions of the Royal... 1973
Review
Topics: Animals; Autonomic Fibers, Postganglionic; Axons; Constriction; Ganglia, Autonomic; Male; Microscopy, Electron; Microtubules; Organoids; Rats; Time Factors
PubMed: 4157143
DOI: 10.1098/rstb.1973.0002 -
Philosophical Transactions of the Royal... Jun 1971
Topics: Adenosine Triphosphate; Adrenal Medulla; Animals; Autonomic Fibers, Postganglionic; Cats; Cattle; Centrifugation, Density Gradient; Chromaffin System; Dogs; Dopamine beta-Hydroxylase; Immune Sera; Immunodiffusion; Iproniazid; Nerve Tissue Proteins; Neurons; Norepinephrine; Organoids; Reserpine; Spleen; Sympathetic Nervous System
PubMed: 4399623
DOI: 10.1098/rstb.1971.0060 -
Journal of Neurology Apr 2000We compared three neurophysiological methods for assessing small nerve fiber function in 40 patients with peripheral neuropathy to determine the various manifestation...
We compared three neurophysiological methods for assessing small nerve fiber function in 40 patients with peripheral neuropathy to determine the various manifestation types of peripheral small fiber neuropathy. Heart rate variation tests were used to assess cardiac parasympathetic small fiber function. Cutaneous vasoconstrictor responses (sympathetic C fibers) induced by deep inspiration were examined with laser Doppler flowmetry. Cutaneous afferent C fiber function was assessed by measurement of axon reflex vasodilatation induced by histamine iontophoresis. All test parameters were significantly lower in patients with peripheral neuropathy than in control subjects. Comparison of the three small fiber systems revealed that functionally different systems are damaged independently, and isolated affection of each fiber type was frequently observed. The three tests are useful noninvasive tools with which to evaluate sympathetic, parasympathetic, and afferent small fiber function in patients with peripheral neuropathy. In many patients functionally different small fiber systems are affected selectively. To diagnose small fiber neuropathy and to evaluate the individual type of manifestation complementary testing of several small somatic and autonomic fiber systems is necessary.
Topics: Adult; Aged; Aged, 80 and over; Female; Heart Rate; Humans; Male; Middle Aged; Nerve Fibers; Neurons; Nociceptors; Parasympathetic Fibers, Postganglionic; Peripheral Nervous System Diseases; Regional Blood Flow; Skin; Skin Physiological Phenomena; Sympathetic Fibers, Postganglionic; Vasoconstriction
PubMed: 10836618
DOI: 10.1007/s004150050582 -
Clinical Autonomic Research : Official... Jun 2021Post-COVID-19 syndrome is a poorly understood aspect of the current pandemic, with clinical features that overlap with symptoms of autonomic/small fiber dysfunction. An...
PURPOSE
Post-COVID-19 syndrome is a poorly understood aspect of the current pandemic, with clinical features that overlap with symptoms of autonomic/small fiber dysfunction. An early systematic analysis of autonomic dysfunction following COVID-19 is lacking and may provide initial insights into the spectrum of this condition.
METHODS
We conducted a retrospective review of all patients with confirmed history of COVID-19 infection referred for autonomic testing for symptoms concerning for para-/postinfectious autonomic dysfunction at Mayo Clinic Rochester or Jacksonville between March 2020 and January 2021.
RESULTS
We identified 27 patients fulfilling the search criteria. Symptoms developed between 0 and 122 days following the acute infection and included lightheadedness (93%), orthostatic headache (22%), syncope (11%), hyperhidrosis (11%), and burning pain (11%). Sudomotor function was abnormal in 36%, cardiovagal function in 27%, and cardiovascular adrenergic function in 7%. The most common clinical scenario was orthostatic symptoms without tachycardia or hypotension (41%); 22% of patients fulfilled the criteria for postural tachycardia syndrome (POTS), and 11% had borderline findings to support orthostatic intolerance. One patient each was diagnosed with autoimmune autonomic ganglionopathy, inappropriate sinus tachycardia, vasodepressor syncope, cough/vasovagal syncope, exacerbation of preexisting orthostatic hypotension, exacerbation of sensory and autonomic neuropathy, and exacerbation of small fiber neuropathy.
CONCLUSION
Abnormalities on autonomic testing were seen in the majority of patients but were mild in most cases. The most common finding was orthostatic intolerance, often without objective hemodynamic abnormalities on testing. Unmasking/exacerbation of preexisting conditions was seen. The temporal association between infection and autonomic symptoms implies a causal relationship, which however cannot be proven by this study.
Topics: Adult; Aged; Autonomic Dysreflexia; Autonomic Fibers, Postganglionic; Autonomic Nervous System Diseases; COVID-19; Dizziness; Female; Hemodynamics; Humans; Male; Middle Aged; Neurologic Examination; Orthostatic Intolerance; Postural Orthostatic Tachycardia Syndrome; Retrospective Studies; Shy-Drager Syndrome; Young Adult; Post-Acute COVID-19 Syndrome
PubMed: 33860871
DOI: 10.1007/s10286-021-00803-8 -
Muscle & Nerve Jan 2009Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was... (Review)
Review
Distal symmetric polyneuropathy (DSP) is the most common variety of neuropathy. Since the evaluation of this disorder is not standardized, the available literature was reviewed to provide evidence-based guidelines regarding the role of autonomic testing, nerve biopsy, and skin biopsy for the assessment of polyneuropathy. A literature review using MEDLINE, EMBASE, Science Citation Index, and Current Contents was performed to identify the best evidence regarding the evaluation of polyneuropathy published between 1980 and March 2007. Articles were classified according to a four-tiered level of evidence scheme and recommendations were based on the level of evidence. (1) Autonomic testing may be considered in the evaluation of patients with polyneuropathy to document autonomic nervous system dysfunction (Level B). Such testing should be considered especially for the evaluation of suspected autonomic neuropathy (Level B) and distal small fiber sensory polyneuropathy (SFSN) (Level C). A battery of validated tests is recommended to achieve the highest diagnostic accuracy (Level B). (2) Nerve biopsy is generally accepted as useful in the evaluation of certain neuropathies as in patients with suspected amyloid neuropathy, mononeuropathy multiplex due to vasculitis, or with atypical forms of chronic inflammatory demyelinating polyneuropathy (CIDP). However, the literature is insufficient to provide a recommendation regarding when a nerve biopsy may be useful in the evaluation of DSP (Level U). (3) Skin biopsy is a validated technique for determining intraepidermal nerve fiber (IENF) density and may be considered for the diagnosis of DSP, particularly SFSN (Level C). There is a need for additional prospective studies to define more exact guidelines for the evaluation of polyneuropathy.
Topics: Autonomic Nervous System Diseases; Axons; Biopsy; Electrodiagnosis; Evidence-Based Medicine; Humans; Neural Conduction; Peripheral Nerves; Polyneuropathies; Predictive Value of Tests; Sensory Receptor Cells; Skin; Sympathetic Fibers, Postganglionic
PubMed: 19086069
DOI: 10.1002/mus.21227 -
Journal of the Autonomic Nervous System Jul 1982Transmission of impulses of pre- to postganglionic neurons supplying skeletal muscle and skin of the cat's hindlimb and tail was investigated. The objective of the study...
Transmission of impulses of pre- to postganglionic neurons supplying skeletal muscle and skin of the cat's hindlimb and tail was investigated. The objective of the study was to determine whether these postganglionic neurons can be influenced from the preganglionic side by non-nicotinic synaptic mechanisms in the lumbar sympathetic chain ganglia. The activity of the postganglionic neurons was recorded from their axons being isolated from peripheral skin and muscle nerves. (1) Vasoconstrictor neurons can be activated by muscarinic action of released acetylcholine and by a non-cholinergic synaptic mechanism. This type of non-nicotinic excitation of postganglionic vasoconstrictor neurons requires the activation of thin, probably unmyelinated preganglionic axons and considerable summation. Postganglionic sudomotor and pilomotor neurons cannot be activated in this way. (2) Ongoing activity in postganglionic vasoconstrictor neurons, but not in sudomotor neurons, can be enhanced for up to 60 min by brief trains of stimuli applied to the preganglionic site. Also this enhancement requires the activation of thin preganglionic axons. (3) Stimulation of thin preganglionic axons leads to an activation of muscle vasoconstrictor neurons via non-nicotinic synaptic mechanisms in the ganglia after complete block of nicotine transmission. (4) Postganglionic vasoconstrictor neurons and sudomotor neurons may be inhibited by a catecholaminergic autogenic mechanism in the ganglia. (5) The results indicate that integration may take place in the sympathetic chain ganglia by other than divergent and convergent processes. In this integration muscarinic actions of released acetylcholine and non-cholinergic synaptic mechanisms may be involved.
Topics: Acetylcholine; Animals; Autonomic Fibers, Postganglionic; Autonomic Fibers, Preganglionic; Axons; Cats; Electric Stimulation; Evoked Potentials; Hindlimb; Muscles; Neurons; Receptors, Nicotinic; Skin; Spinal Cord; Synaptic Transmission; Tail; Vasoconstriction; Vasomotor System
PubMed: 6290564
DOI: 10.1016/0165-1838(82)90026-1