Funct Neurol
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The aim of this paper is to discuss whether in the realm of diseases of the nervous system the concept of "dysfunctional" versus "organic" disorders is still useful. The knowledge on the Common Brain Stem System (CBSS) described by Hess is reviewed in order to underline its role as a control centre integrating all the homeostatic and adaptive nervous activities, and in this context, the nervous control of the cardiovascular system is examined, particularly in relation to higher nervous activities. The neurogenic syncopes are chosen as examples of the either "organic" or "dysfunctional" conditions whose semeiotic and pathophysiological distinctive features are analysed. In conclusion the distinction between "organic" diseases and "dysfunctional" disorders seems to be still justified, mainly for the nervous affections involving the homeostatic-adaptive properties of the CBSS.
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There is a spectrum of conditions which have in common burning pain, often with hyperpathia, hyperalgesia, vasomotor and sudomotor changes. When due to major nerve damage, the condition is known as causalgia; when due to minor nerve damage or other factors, various terms such as algodystrophy or reflex sympathetic dystrophy are employed. ⋯ The classical view that the peripheral sympathetic nervous system is involved in generation of pain is questioned, and the possible roles of the central nervous system and of non-adrenergic mechanisms are summarised. That pain could be due to dysfunction of the polymodal nociceptor neurone is considered.
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Painful neurogenic syndromes commonly diagnosed as reflex sympathetic dystrophy (RSD) may not be the consequence of sympathetic dysfunction. Recent experimental data on the mechanism of hyperalgesia indicate that the primary pathophysiological mechanism of RSD may be sensitization of either peripheral nociceptors, or central neurons, or both. The sympathetic system might be involved in maintaining this condition, but this is not always the case. This presentation is an attempt to interpret clinical neuropathic syndromes on the basis of new scientific knowledge.
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The term "sympathetically maintained pain" does not imply that the pains are due to the sympathetic system. It is not a matter of excessive or decreased sympathetic activity. ⋯ This fact suggests that we are not concerned primarily with abnormal states induced by the sympathetic system, but with a general kind of abnormality of the total nervous system. This phenomenon may be relieved by removal of the sympathetic nerves to the relevant neurons of the periphery.