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CHAPTER 28
Side effects on autonomic mechanisms
This chapter would not be complete without mentioning some undesirable side effects
of prostigmin on the cardio-vascular system and other components of autonomic
mechanisms. Headaches, sweating and vomiting may occur, regardless of the level of the
lesion, and if vomiting becomes more marked, it may counteract the prostigmin's
stimulating effect on the reproductive organs. It can be controlled by i/ioo Atropine.
Only in 3 cases, was it thought wise to give an intravenous drip of saline to prevent
dehydration. It has already been mentioned that, in cord lesions above T5 and in parti
cular cervical lesions, violent contractions of the ejaculatory organs can set up that stress
response of autonomic mechanisms described as a result of bladder distension (Guttmann
& Whitteridge, 1947), resulting in exaggerated autonomic hyperreflexia with considerable
rise of systolic and diastolic blood pressure. In one case, with complete tetraplegia below
Cy, the initial blood pressure of 90/70 rose during the ejaculatory stage of the test to
230/150. Immediate application of Pentolonium (Ansolysen) intravenously immediately
reduced the paroxysmal hypertension. It may be noted that in this case a previous cysto-
metrogram revealed a very irritable disco-ordinated automatic bladder, and an infusion
of only 50 cc of fluid into the bladder elicited repeated and most powerful detrusor
contractions. Therefore, it is advisable to carry out a cystometrogram prior to the
prostigmine test in high cord lesions to ascertain the threshold and degree of irritability
of autonomic mechanisms. Cerebral haemorrhages due to exaggerated autonomic
hyperreflexia resulting in hypertensive episodes have been recorded following bladder
distension and during the last stages of labour in high lesions (Thompson & Witham,
1948; Jung & Schmidt, 1962). We lost one tetraplegic with a complete C6/7 lesion. He
had his first prostigmin test on 2 February 1948, when following injections of 0-3 mg
the initial blood pressure rose from 120/85 to I 5°/9°- Apart from vomiting, which was
controlled by i/ioo Atropine, there were no undesirable side effects during 3 ejaculations.
He got married, and in 1961 he asked for a prostigmin test for the purpose of artificial
insemination. This was carried out on 15 September 1961. One and a half hours following
injection of the same doses as previously (0-3 mg), he developed an epileptic fit and died
later, as a result of a cerebral ventricular haemorrhage. At
post-mortem
an undiagnosed
abscess behind the pancreas was also found. Recently, Rossier
et al.
(1971) studied in
detail for the first time the cardio-vascular changes during ejaculations following prostig
min test, in a traumatic tetraplegic, by intra-arterial monitoring with simultaneous
electro-cardiography and catecholamine estimation in blood and urine. Hypertension
during ejaculation was accompanied by cardiac arhythmia, and a close relationship was
found between the stress response of the cardio-vascular mechanisms and a rise in
catecholamine levels. From all these and other author's observations the following con
clusions can be made:
1
The widespread belief that patients with severe injuries of the spinal cord are com
pletely and permanently impotent and infertile is no longer valid.
2 The distinct stimulating effect of intrathecal prostigmine on the sexual organs has
opened new possibilities for clinical, physiological and biochemical research in a field
