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sympathetic dysfunction as a cause for hypotension in dengue shock syndrome

Chinese Medical Journal 2012年第20期125卷 3757-3758页

作者： Jeevagan Vijayabala Malith Attapaththu Priyankara Jayawardena garath Gamini de Silva Godwin Constantine University Medical Unit National Hospital of Sri Lanka Sri Lanka Asiri Hospital Colombo Sri Lanka

Dengue is an important mosquito-borne disease, caused by one of the four serotypes of dengue *** to the reports from the World Health Organization, every year 50 to 100 million infections occur, including 500 000 dengue hemorrhagic fever cases and 22 000 deaths, mostly among children.1 The main features of severe infection are hypotension, fluid leak and shock. Management of dengue shock syndrome and its pathophysiology are not fully understood. We reported two patients with dengue who developed hypotension without considerable fluid accumulation in the third space and explaining an alternative cause for hypotension in these patients.

关键词： dengue shock syndrome," hypotension sympathetic dysfunction

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Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury

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Neural Regeneration Research 2017年第9期12卷 1390-1400页

作者： Hisham Sharif Shaoping Hou Spinal Cord Research Center Department of Neurobiology and Anatomy Drexel University College of Medicine

Autonomic dysreflexia （AD） is a serious cardiovascular disorder in patients with spinal cord injury （SCI）. The primary underlying cause of AD is loss of supraspinal control over sympathetic preganglionic neurons （SPNs） caudal to the injury, which renders the SPNs hyper-responsive to stimulation. Central maladaptive plasticity, including C-fiber sprouting and propriospinal fiber proliferation exaggerates noxious afferent transmission to the SPNs, causing them to release massive sympathetic discharges that result in severe hypertensive episodes. In parallel, upregulated peripheral vascular sensitivity following SCI exacerbates the hypertensive response by augmenting gastric and pelvic vasoconstriction. Currently, the majority of clinically employed treatments for AD involve anti-hypertensive medications and Botox injections to the bladder. Although these approaches mitigate the severity of AD, they only yield transient effects and target the effector organs, rather than addressing the primary issue of central sympathetic dysregulation. As such, strategies that aim to restore supraspinal reinnervation of SPNs to improve cardiovascular sympathetic regulation are likely more effective for AD. Recent pre-clinical investigations show that cell transplantation therapy is efficacious in reestablishing spinal sympathetic connections and improving hemodynamic per- formance, which holds promise as a potential therapeutic approach.

关键词： autonomic dysreflexia hyper-reflexia sympathetic dysfunction C-fibers propriospinal axons a-adrenoceptors stem cell transplantation

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