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Abstract: Objective: To understand the physiopathology and the consequences of a traumatic spinal cord injury after the acute phase. The aim is to describe the preoperative management of these patients and the various anaesthetic techniques available. Data source: The data were retrieved from the PubMed data base, papers from the major French anaesthesiology and intensive care conventions, publications from the French medico-surgical encyclopaedia, combined with reference analysis of major articles in this field. Results: In France, there are 40,000 patients with traumatic spinal cord injury. These lesions lead to major handicap and frequent complications particularly urologic and orthopaedic ones. These patients often require surgical procedures under anaesthesia. Besides neurological deficits, the spinal cord injury leads to an imbalance between sympathetic and parasympathetic nervous systems with serious dysautonomic complications. During surgery, anaesthesia is necessary to prevent this autonomic dysreflexia. All anaesthetic techniques are usable and effective, subject to their careful implementation for those patients with cardiovascular and respiratory restricted adaptation. The use of suxamethonium can induce fatal hyperkaliemia for up to 10 years after the initial injury, with maximal frequency at six months post-trauma. Conclusion: Notwithstanding insensitivity resulting from a spinal cord lesion, it is necessary to anaesthetize these patients before all surgical procedures. [Copyright &y& Elsevier]

Abstract: This paper describes the conditions under which autoimmune T cells enter the central nervous system to attack the local tissue. During a prodromal period preceding the onset of neurological disease, the CNS tissue is converted from its physiological immune-hostile state to an immune-friendly state. At the same time, in the peripheral immune system, activated autoimmune T cells undergo profound changes that allow them to enter through the blood-brain barrier and to finally interact with local autoantigen-presenting cells. Antigen recognition leads to T cell activation and the secretion of inflammatory mediators that are responsible for the development of the inflammatory lesions and the neurological deficits. To cite this article: H. Wekerle, C. R. Biologies 330 (2007). [Copyright &y& Elsevier]