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The spinal component to skin blood flow abnormalities in reflex sympathetic dystrophy
H A Kurvers1, M J Jacobs, R J Beuk
1Department of Surgery, University Hospital Maastricht, The Netherlands.
Archives of Neurology
|January 1, 1996
Summary
Reflex sympathetic dystrophy involves a spinal component, not just peripheral issues, particularly in early stages. This neuropathic pain syndrome
Area of Science:
- Neurology
- Pain Medicine
- Microcirculation Research
Background:
- Reflex sympathetic dystrophy (RSD) is a neuropathic pain syndrome.
- RSD is characterized by skin blood flow abnormalities.
- The origin of RSD mechanisms (peripheral vs. spinal) and pathways (neural vs. humoral) is debated.
Purpose of the Study:
- To investigate if RSD mechanisms have a spinal component.
- To determine if RSD acts solely through neural pathways or also involves humoral pathways.
Main Methods:
- Studied 54 patients with unilateral RSD, categorized into three stages based on skin temperature.
- Assessed basal skin blood flow and vasoconstrictive response to dependency in affected and unaffected hands.
- Utilized Doppler laser flowmetry (thermoregulatory level) and capillary microscopy (nutritive level).
Main Results:
- In stage I RSD, the unaffected hand showed increased basal skin blood flow and attenuated vasoconstrictive response at the thermoregulatory level.
- No significant differences were observed between affected and unaffected hands in stage I.
- No differences in microcirculation were found at stages II and III, or at the nutritive level in any stage.
Conclusions:
- Stage I RSD exhibits microcirculatory abnormalities with a spinal component.
- These abnormalities likely involve neural mechanisms, specifically antidromic vasodilation.
- The syndrome may be initiated by peripheral nerve trauma.