Autonomic Nervous System Dysfunction Following Spinal Cord Injury: Cardiovascular, Cerebrovascular, and Thermoregulatory Effects

Deficits in motor and sensory function secondary to spinal cord injury (SCI) are well appreciated and can be clinically assessed using the International Standards for the Neurological Classification of SCI (ISNCSCI), which were revised in 2010 and a dataset published in 2012. Subsequently, the International Standard on documentation of remaining Autonomic Function after SCI was established in 2012, which is to be used as an adjunct to the ISNCSCI exam. The autonomic nervous system is responsible, solely, or in part, for regulation of many physiological processes and the impact of SCI on this regulatory process cannot be overstated. However, given that most of these physiological processes occur without voluntary or conscience action, assessment of deficits in autonomic control is limited to end-organ function. Over the past 10 years, our knowledge regarding the underling pathophysiology of autonomic dysfunction after SCI has greatly improved. This review will focus on what is currently known and published regarding the loss of integral autonomic control of the heart and circulation and the consequent effects on the cerebral vasculature and thermoregulation.