The spinal component to skin blood flow abnormalities in reflex sympathetic dystrophy

被引:41
作者
Kurvers, HAJM
Jacobs, MJHM
Beuk, RJ
vandenWildenberg, FAJM
Kitslaar, PJEHM
Slaaf, DW
Reneman, RS
机构
[1] UNIV LIMBURG HOSP,DEPT SURG,6202 AZ MAASTRICHT,NETHERLANDS
[2] UNIV AMSTERDAM,ACAD MED CTR,1105 AZ AMSTERDAM,NETHERLANDS
[3] CARDIOVASC RES INST,DEPT BIOPHYS,MAASTRICHT,NETHERLANDS
[4] CARDIOVASC RES INST,DEPT PHYSIOL,MAASTRICHT,NETHERLANDS
[5] CARDIOVASC RES INST,DEPT SURG,MAASTRICHT,NETHERLANDS
关键词
D O I
10.1001/archneur.1996.00550010076019
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: To determine whether the mechanisms of reflex sympathetic dystrophy, a neuropathic pain syndrome characterized by skin blood flow abnormalities associated with sympathetic vasoconstrictor and antidromic vasodilator mechanisms, are solely of peripheral origin or have an additional spinal component and act exclusively through neural or also involve humoral pathways. Patients: The 54 patients with unilateral reflex sympathetic dystrophy were divided into the following three stages according to their perception of skin temperature in the clinically affected hand: stage I, stationary warmth sensation; stage II, intermittent warmth and cold sensation; and stage III, stationary cold sensation. Methods: Investigation of basal skin blood flow and vasoconstrictive response to dependency of skin microvessels in the clinically unaffected hand and the clinically affected hand of patients with reflex sympathetic dystrophy and the left hand of 16 control subjects. Microcirculation was investigated at the predominantly neurally controlled thermoregulatory level (Doppler laser flowmetry) and at the predominantly humorally controlled nutritive level (capillary microscopy). Results: In the clinically unaffected hand, at the thermoregulatory level of the microcirculation: (1) basal skin blood flow was increased at stage I compared with the control subjects, whereas no differences could be observed at this stage compared with the clinically affected hand; (2) the vasoconstrictive response to dependency (defined as skin blood flow at heart level divided by skin blood flow in the dependent position) was attenuated at stage I compared with the control subjects, whereas no differences could be observed at this stage compared with the clinically affected hand; and (3) basal skin blood flow and the vasoconstrictive response to dependency did not differ from the control subjects at stages II and III. In the clinically unaffected hand, at the nutritive level, no differences could be observed at any stage of the syndrome compared with the control subjects. Conclusions: This study indicates that there is a spinal component to microcirculatory abnormalities at stage I of the reflex sympathetic dystrophy syndrome that most likely acts through neural (antidromic vasodilator) mechanisms and that may be initiated by traumatic excitation of a peripheral nerve on the clinically affected side.
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页码:58 / 65
页数:8
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