H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY  

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

The Role Of Neuro-Inflammation In Pathophysiology Of Thermal Regulation

The body temperature is modulated by the sympathetic nervous system (SNS) at two levels.

1. Skin provides a rich arteriole venous shield of 200 ml/mm blood flow providing heat preservation (vasoconstriction), or heat emission (vasodilation and hyperthermia).

2. Centrally, the spinal cord and hypothalamus modulate the surface and deep circulation simultaneously and bilaterally. With cold exposure, the spinal cord provides superficial vasoconstriction and deep vasodilation. With heat exposure, the mechanism is reversed.

The sympathetic system has three main functions:

1. Thermal regulation.

2. Control of vital signs (blood pressure, pulse and respiration).

3. Control of the immune system.

All three functions are essential for preservation of milieu interne. The neuro-inflammation is a physiopathologic response of the body against any stressor. Neurodermatitis of emotional stress, edema of the extremity in CRPS, profuse skin ulcers in venipuncture RSD, sterile osteonecrosis involving the facial bone or bones in the extremities, and modulation of the T-cell lymphocytes in late stages of neuropathic pain and CRPS are some of the examples of neuro-inflammation. The sympathetic system shows a uniform response to a stressor be it infectious, traumatic, emotional, or prolonged inactivity.

If the neuro-inflammation is not properly diagnosed and treated, the patient will end up with unnecessary surgeries for carpal tunnel, tarsal tunnel, or thoracic outlet syndrome. The trauma of surgery secondarily initiates a new round of more severe neuro-inflammation, edema, and entrapment.

Neuro-inflammation is the key to understanding the hyper-and hypothermic spots in Infrared thermal imaging (ITI). Peripheral nerve injury causes vasoconstriction distally, and vasodilation in the corresponding paravertebral nerve regions. This hyperthermic vasodilation in the paraspinal regions is due to transmission of substance P (SP) and nitric oxide (NO), and other neurokines from periphery to the spinal cord. Prolonged neurokine transmission and accumulation at paraspinal nerves distribution causes neck pain, low back pain, headache, and vertebral arteries constriction secondary to vertigo, falling attacks, and blurred vision. Epidural and paravertebral nerve blocks correct this condition. However, any type of trigger point or nerve block injection should be done proximally rather than distally in the area of pathology. Any needle insertion in the distal portion of the extremity will add more trauma and aggravation of the neuropathic pain and vasoconstriction.

H. Hooshmand, M.D.