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PubMed2006

Alpha-synuclein pathology of the spinal and peripheral autonomic nervous system in neurologically unimpaired elderly subjects.

Studies on cases with incidental Lewy body disease (ILBD) suggest that alpha-synuclein (alphaSN) pathology of Parkinson's disease (PD) starts in lower brainstem nuclei and in the olfactory bulb. However, medullary structures as the induction site of alphaSN pathology have been questioned as large parts of the nervous system, including the spinal cord and the peripheral autonomic nervous system (PANS), have not been examined in ILBD. Thus, the time course of PD lesions in the spinal cord or PANS in relation to medullary lesions remains unknown. We collected 98 post mortem cases with no reference to PD-associated symptoms on clinical records. alphaSN pathology was found in the central nervous system, including the spinal cord, and in the PANS in 17 (17.3%) cases. alphaSN pathology was encountered in autonomic nuclei of the thoracic spinal cord, brainstem and olfactory nerves in 17/17, in sacral parasympathetic nuclei in 15/16, in the myenteric plexus of oesophagus in 14/17, in sympathetic ganglia in 14/17, and in the vagus nerve in 12/16 cases. In addition to the thoracic lateral horns, a high number of alphaSN lesions was also found in non-autonomic spinal cord nuclei. Considering supraspinal structures our cases corresponded roughly to the recently described sequential order of alphaSN involvement in PD. Our study indicates, however, that the autonomic nuclei of the spinal cord and the PANS belong to the most constantly and earliest affected regions next to medullary structures and the olfactory nerves. A larger cohort of ILBD cases will be needed to pinpoint the precise induction site of alphaSN pathology among these structures.

Aged↗
PubMed2001

[Physiology of the urethral sphincteric vesico-prostatic complex].

We propose a review of the literature about innervation and physiology of the urethral sphincteric complex. Parasympathetic innervation of the pelvic viscera comes from ventral branches of the sacral nerves (S2-S4). The orthosympathetic component derives from superior hypogastric plexus and runs down the hypogastric nerves to form the right and left pelvic plexus together with the parasympathetic component. The pelvic plexus is situated inferolaterally with respect to the rectum and runs on the surface of the levator ani muscle down to the prostatic apex. The pelvic plexus gives innervation to the rectum, the bladder, the prostate and the urethral sphincteric complex. The pelvic muscular floor is innervated by the somatic component (pudendal nerve) derived from the sacral branches (S2-S4). Bladder neck and smooth muscle urethral sphincter innervation is given mostly by the orthosympathetic component. The rhabdosphincter innervation comes from the pudendal nerve and from the pelvic plexus; its role in the continence mechanism is probably to give steady tonic urethral compression. Levator ani muscle takes part in the sphincteric complex with its anteromedial pubococcygeal portion. It plays its role strengthening the sphincteric tone during increase of the abdominal pressure or during active quick stop cessation of the urinary stream.

Humans↗
PubMed2004

Anatomy of the pelvic plexus and innervation of the prostate gland.

We have examined the anatomy of the pelvic (inferior hypogastric) plexus in six male cadavers, paying particular attention to gross anatomical landmarks that might aid in locating it and have used immunohistochemistry to study the small branches of the plexus that supply the prostate gland. The pelvic plexus was found two finger breadths lateral to the third anterior sacral foramina, lying deep to a line drawn from third sacral vertebra, the conventional level of the recto-sigmoid junction, and the palpable posterior superior surface of the pubic symphysis. Immunohistochemical staining showed small nerve branches from the pelvic plexus entering the prostate gland and the presence of ganglia within the prostate gland that contained both tyrosine hydroxylase positive and negative neuronal cell bodies. This information may be useful in nerve-sparing surgical procedures and in discussions of the functional implications of perturbations of prostate innervation.

Aged↗
PubMed1985

New concepts in severe presacral hemorrhage during proctectomy.

In the past, surgeons thought that severe presacral hemorrhage during proctectomy was caused by damage of the presacral venous plexus. By studying the anatomy and clinical data, we found that injury of the sacral basivertebral vein also caused this serious complication. Presacral hemorrhage is seen as massive bleeding from the distal pelvic surface of sacrum or from one to several large-caliber foramina of sacral basivertebral veins in that area. This type of presacral hemorrhage is more dangerous than that from simple injury of presacral venous plexus and sometimes it is fatal. We describe the anatomic features of the vertebral venous system and its close relationship with severe presacral hemorrhage. We also propose some new concepts about cause, hemostatic measures, and principles of prevention.

Adult↗
PubMedDate not supplied

[Techniques for opacification of the lumbar spinal venous plexuses (author's transl)].

No single technique exists for lumbar phlebography. Whilst catheterisation of the ilio-lumbar veins is always the first step, it should be routinely followed by injection of the lateral sacral veins whenever the leel L5-S1 is clinically suspicious. Finally, when only poor opacification of the longitudinal epidural plexuses is obtained by filateral injection of the ilio-lumbar or ilio-lumbar and sacral systems, catheterisation of the vein in L2 on the right or L3 on the left makes it possible in virtually all cases to obtain satisfactory filling of the lumbar plexuses. It may be considered at the present time that, from a technical standpoint, failures of lumbar phlebography by bilateral femoral catheterisation do not exceed 1% of cases.

Humans↗
PubMed1984

Subtle neurological injuries in pelvic fractures.

Eleven of 28 patients with a fracture of the acetabulum, pelvis, or sacrum were found to have electromyographic changes, apparently due to injury to the lumbosacral plexus. There appears to be a higher incidence associated with sacral fracture or sacroiliac separation (64%) than with acetabular fracture (24%). The EMG changes are diffuse and the clinical manifestations are subtle but the changes do interfere with the rehabilitation process.

Acetabulum↗
PubMed1990

[A case of delayed radiation lumbo-sacral plexopathy].

We report a 47-year-old woman who developed a slowly progressive lumbosacral plexopathy with mixed sensorimotor losses in the lower extremities. The symptoms were apparent 8 years after x-ray irradiation for an ovarian carcinoma. Neurological examination showed mild weakness and absent deep tendon reflexes of bilateral lower extremities, and hypesthesia to all modalities in anterior aspects of bilateral lower thighs, in dorsum pedis and soles. Extensive investigations regarding the possibility of tumor recurrence were negative. Computed tomography of pelvis showed abnormal soft tissue densities around the lumbosacral plexus. Intravenous pyelography showed bilateral hydronephrosis and narrowed ureters at the first sacral vertebra level. These findings are consistent with radiation-induced fibrosis rather than tumor infiltration. The results suggest the entrapment lumbosacral plexopathy due to surrounding fibrosis after irradiation. We speculated the sensorimotor losses caused by entrapment of the lumbosacral plexus.

Female↗
PubMed2004

Factors affecting the spread and duration of epidural anesthesia with ropivacaine.

BACKGROUND: Epidural anesthesia has an unpredictable extent and duration. Differences in the surface area of the lumbosacral dura, epidural fat volume, and epidural venous plexus velocity might explain the variability in the extent and duration of epidural anesthesia with ropivacaine. METHODS: Twenty-six healthy patients, aged 18-45 y, undergoing peripheral orthopedic surgery were enrolled. Dural surface area and posterior epidural fat volume were calculated from low thoracic, lumbar, and sacral axial magnetic resonance images obtained at 8-mm increments. Epidural venous plexus velocity at the L3-L4 disk level was derived from phase-contrast magnetic resonance images. The patients received 100 mg ropivacaine (1.0%) epidurally. The spread and duration of sensory anesthesia was assessed by pinprick, and that of motor block was assessed using a modified Bromage scale. Statistical correlation coefficients (rho) between magnetic resonance imaging and epidural anesthesia measurements were assessed by Spearman rank correlation. Stepwise multiple linear regression models were used to select important predictors of measures of epidural anesthesia. RESULTS: Dural surface area correlated with peak sensory block level (rho= -0.73, P = 0.0003) and onset time of caudal and cephalad block (rho = 0.62, P = 0.002; rho = -0.63, P = 0.002). Fat volume correlated with the regression to L5-S3 (rho = -0.44.44 to -0.54, P = 0.029 to 0.007). Epidural venous plexus velocity was significantly correlated with the regression to L3 (rho = -0.42, P = 0.038) and L4 (rho = -0.48, P = 0.017). Multiple regression analysis revealed that dural surface area was a significant predictive variable for the peak sensory block level (R = 0.61, P < 0.0001). CONCLUSIONS: These findings indicate that dural surface area influences the spread of epidural anesthesia with ropivacaine and posterior fat volume influences the duration of epidural anesthesia in healthy patients within a narrow age range. Epidural venous plexus velocity might also influence the duration of epidural anesthesia with ropivacaine.

Adipose Tissue↗